Community 139 Colleges DRAWING STUDIOS Space requirements related to type of drawing and allied work, it any, to be undertaken —(1). Work station sizes in part conditioned by eqp needed to accommodate drawing format to be adopted. Except in USA most offices committed to 'A' series of international paper sizes: smaller formats obtained by halving larger dimensions in each instance —*p3—5. For most industrial, engineering and design consultants drawing requirements can be accommodated by AD format; drawing boards and drafting machines sized accordingly. Simplest form of work station: drawing board, eqp trolley (cart) and draughtsman's stool; where dratting work requires reterence contained on other drawings either reference tables or vertical screens may be used carry this information. Screens have advantage of keeping floor area needed to mm but at expense of controlled supervision. Reterence tables, which may also provide plan chest drawing sf0 below work surface, either to side of draughstman in parallel with drawing board or at right angles to it. Further possibility available with 'back reference' where reference table also support for drawing board behind. Where drafting function only part of job requirement and admin work also to be done reference area may double as off desk or, if space allows, desk may form additional element within work station. 1 Various planning arrangements Reterence may not be confined to intormation contained on drawings; otten need have comprehensive set reference books or manuals close at hand for draughtsman: may be housed communally or at each work station. Further category of drawing studio that allied to workshops where tull-sized setting-out drawings (USA shop drawings) (or workshop 'rods') prepared. Usually allied to construction industry, in particular joinery shops; such drawings prepared on rolls of paper set down at long benches. Draughtsmen work standing up at drafting surtace which is horizontal and 900 from FFL. Original drawings stored in roll form rather than sheet as in other studios, tor which housing may be either horizontal (plan chests with drawers) or vertical (plan file cabinets). Layout of any studio therefore conditioned by type of work being undertaken and type of supervision required. In all studios good lighting essential, both daylight and artiticial; windows should have N to E aspect. If this not possible windows should be fitted with blinds to screen direct sunlight and prevent glare. Ancillary areas may include printing and reprographic eqp; this may be housed in studio or, it sophisticated or large scale, sited in separate area. Archive sf0 tor original drawings which may have to be kept tor indefinite period should be properly conditioned tor sf0 of paper and housings must be fire and flood proot. Present trend increased use of computer processes tor production of working drawings; use at such eqp may influence spatial requirements of future drawing studios. 5 Typical small photocopying machine used in drawing off for reproducing plans t. 920 1 300 —-. -t 920 1 300 ,92O 1 300÷ utilisation 6.03 m2/P utihsation 6.03 m2/P L - — 460k _______ i--- utiiiisation 5.01 m2/P 1300 1300 1300 90 utihsation 4.2 m2/P F F utilisation 5.01 m2/P 1 300 )300300q1300 13001300 1300 I ¶ ¶ screenwith 920V pin board ji*atLofl42m/P — ——'———— j__ ——J 920 I ______ utilisation 5 1 m2/P -1 300 reference table 90 board ---. .: ... under drawing trolley utiiisation - 3.45 rn/P 9 920 18 utilisation 4.23 m2/P drawing board 1 300 920 920 90 __________ utiisation 5.9 m2/P LI reference table chair 2 Drawings best kept in tr cabinets I 210 1 750 3 Steel chest for plans 4 Drawing table: standard sizes 1000 x 1500&1250x 2000;h 2050 (USA941 x 1092—1067x 2390; h 940)
140 Community Colleges STUDENT HOSTELS: PLANNING FACTORS L_Ii I Singlestu/bedrwithhb: 10m2 2 Singlestu/bedr: longershape provides more economical use of space 5 Double stu/bedr 1 divan B 2 curtain 3 desk with drawer unit 4 easy chair 5 heating convector 6 book shelf over 7 table with bookshelves 8 built-in wa Hostel (USA dormitories) bldg usually financed by university or college from own funds, government grants or loans, open market loans: annual income raised has to cover interest, amortisation, running and maintenance costs. Some governments make grants to subsidise annual income. This can be supplemented by letting for conferences, educational courses, holiday visitors. In some countries educational establishments and student unions have formed businesses provide off bldg for letting so that income can subsidise hostels. Size of hostel rm and amenities to be provided therefore depend on uses bldg can be put to and on annual income obtained. Single students generally need accn for 30—33 week/year. Married usually for 50—52 weeks. Accn should cater for children outside play space and be placed near shopping and social services and amenities. Trend to house students in range of accn for all categories; many students prefer small independent units sharing some variety of accn to institutional residential communities. For social and admin reasons first year students usually placed in halls of residence with staff rm, area kitchen, laundry and ironing rm, toilets, sto etc, meals being taken in dining centre. Dining rm—.p142 Halls with shared dining and social services normally planned as large number of study bedr with central bathr and small kitchen: may also be rm or flat for staff member provide supervision. In recent residential bldg provision made for students prepare and take all meals independently in own social groups. Small groups up to 4 students need be self-selected; group of 6—8 socially large enough divide into sub-groups without being too big share cooking eqp successfully; 12 or more do not form cohesive group: shared kitchen with dining rm used for other activities could lead to problems. Conference use requires mm washbasin in each rm with good access car parking, lecture and dining rm: alternative accn for few students in residence during vacations and sto for possessions needed. Independent housing or hostel units favoured by final year and postgraduate; can be in purpose-built groups, located in urban community or converted houses. Shared accn also —p99 ACCOMMODATION REQUIREMENTS 1-bed/study space 9—15 m2; 2-bed/study space 13—19 m2 (unpopular with UK students; liked in USA); self-catering unit total area 16—20 m2: areas may be slightly reduced in family' flats to allow more room for amenity space. Rm to be furnished with bed/divan, desk and chair, shelves and hanging for clothes 0.8—1 m2, open adlustable shelving and pin board, easy chair, small table, bedside table, mirror, bin, rm light and desk/bed lamp, 2 power points, rm heater, carpet, dense curtains/blinds. If wash basin included provide towel rail, mirror, cupboard or shelf, shaver point. Rm showers and wc sometimes included on individual or shared basis. Some rm should be larger to provide for entertaining and meetings. Provide proportion of rm suitable for physically handicapped. Married student accn should comply with normal housing space standards —p44 48: some will have families Provide background heating supplemented by rm heater controlled by occupant. Ensure good sound insulation, especially round service pipes. Shared accn —.p99 Sanitary 1 wc/6 students; 1 bath/6 students, or 1 shower/12 students (preferably 50% baths); 1 wash basin/3 students if not provided in rm. 4 2700 4 3 Single stu/bedr without hb 4 2-student unit, also used for conferences 1 B 2 desk 3 wa 4 bathr 6 Typical staircase access dOue stu/bedr siu/bedr hb liR' ji stul Stu/ SIU/ stui Stu/Stu/ rbedrbedr rbedrbjbedr s,o wc Cpd sk ________ FtL?rrT dJ ' stu/ Irr-' bedr stul lI1-ILll ty bedr sho WCW sk JfstuI stu/Istu/ siu/sStU/ ebedr bedbedr drbedbedr 8 Corr access round service core; e = elevator 7 Typical composite access (corr access similar but continuous between staircase): note position of dr/k ar & shared washr & toilet Space standard 1.2—1.6 m2 USA: check applicable codes and standards for these details. Prefabricated sanitary units —.p65 Hot water heating local or centralised. 10 Typical amenity ar r i -r
Community 141 Colleges STUDENT HOSTELS: ACCOMMODATION (cont) Amenity space Dining kitchens not intended for Cull meal service with utility space allow 1.2—1.6 m2/student. With Cull meal service allow 1.7—2 m2/student (less for more than 6 students). Where hostel close to other university bldg and communal service used, dining kitchen may be only shared social space. Cooking and dining areas should be separated with dining rm located where all students pass it. New accn more likely provide self-catering. Eqp self-catering shared by 6: cooker and refrigerator, single bowl double-drainer sink, 2000— 3000 work top with cupboards under and over (include individual food lockers), refuse with capacity 1 day's use. Provide eqp for washing, drying and ironing for each group of rm. NB: above not normal practice in USA. Residences on campus use communal amenities; where accn some distance from other university bldg allow within hostel m2/student: large common rm 0.9—1.2 lib/reading rm 0.4—1.8 indoor games 0.2—0.4 hobby rm 0.2—0.4 Within these areas also coffee bar/shop, ante-rm/coffee lounge, place for debates and society meetings, television, music practice, lay for visitors as appropriate in accordance with local reg. Offices Large residences away from campus need some off with approx areas (m2): warden/supervisor 20, secretary/archives 20, management committee/consult mi 30, housekeeper* 9, cleaner's changing rm* 9 porter* (next to entrance) 9, students' union 20. * also needed when residence on campus. Staff Design to suit single, married and married with family categories. Some accn within residence provides supervision. Separate accn in houses or flats most economical. Warden needs (m2) 67—93; single academic staff and housekeeper each 56—67; single supervisory staff 46—56; single I Student residence Guildford England a second, first & ground floor domestic staff as for students. plans of typical unit b sections AA & BB c roof plan of court Arch Robert Maguire & Keith Murray Ancillary __________________________________________________________ Allow baggage sto 0.3 m2/student. Provide adequate central sto for household and cleaning eqp, linen, furniture and refuse; on each floor sto for cleaners and eqp with sink and water supply. Provide laundry chute if appropriate. Circulation areas and ducts account for 2—5.7 m2/student. Ensure passages adequate for trolleys (carts) and carrying suitcases. Provide entrance hall supervised by porter with space for notices, telephone kiosks and milk and mail delivery. Bell system or loudspeaker will serve to transmit messages in conjunction with some telephone points. Finishes Materials should be durable, hard and need little maintenance. Layout & building form Single row arrangement: width of bldg 5500, rm 3500, corridor 1500; double row arrangement: width 10 m, 2 rm each 3500, corridor 2000; triple row arrangement: width 14000,2 rm each 3500,2 corridors each 1 500 with artificially lit and ventilated centre block for washr etc. Type of access available: by stairs to rm, by stairs and short corridors, by stairs to central corridors. Adequate means of escape in case of fire must be provided —*p44 91. With 4 floors and more elevators required: more economical build up to 3 storeys. Car parking: mm ratio 1 space/3 students; sto for bicycles and motor cycles also. 2 HaIl of residence next campus Southampton England typical floor plan Arch J S Bonnington Partnership Site footpaths away from ground floor windows and maintain privacy. 3 Quincy House Harvard University USA provides integrated communal services a second floor plan 1 single bedr 24-man duplex suite liv, bedr above or below 3 tutor liv 4 stu 5 bedr b first floor plan 1 k 2 servery 3 dr 4 janitor 5 4-bedr suites 6 liv 7 bedr 8 listening rm 9 workr 10 3-bedr unit 11 reading nn c ground floor plan 1 lower lob 2 grill rrn 3 senior commons 4 junior commons 5 tutorial centre ______ 6 superintendent 7 service & gar 8 entrance lob 9 house off 10 tutor __________________________________________________________ suite 11 guest suite Arch Shepley Bulfinch Richardson & Abbot 03 6m 9 18 ft 036m 9 18 ft b a 2 WJ_LLJL'.U IFTTrTTTTrf.-4 010, Om 326496 ft
142 Community Colleges REFECTORIES/DINING HALLS Can be provided in separate bldg within hostel (dormitory), within community activities bldg or as separate bldg. Space requirements depend on type of service (self-service from counter, self-service from dishes on table, waiter service) and seating arrangement but generally allow 1.2 m2/student, allowing for number of sittings. Long tables with benches —(1) preferable (not USA) to small with chairs: cheaper, durable, space-saving, easy clean and clear. Width of seat 600; width of table 600—(preferably) 700. Space for cross passages: (500 x 1050/3 seats = 0.18 m2); add extra space for side passages and space in front of servery (service) and entrance. Benches should stand 80—100 away from this table; need be only 300 wide and 400—450 high (easy to step over). Benches near wall 400 wide, including 120 distance from wall to give access. More convenient enter from side but this means 4 students on wall bench. For more elaborate furnishing —(2); where chairs and more comfortable tables desired dimensions are: width of seat 650; width of table 700—800. Space required (access from behind —hatched portion): 650 x 1150 = 0.75 m2. Share of cross passages (550 x 1150)/3 = 0.21 m2. Floor area/student with appropriate extra space as above: 1.1—1.2m2. If space along wall behind chairs used as main passage width increased to 800. Tables with seats at either end —(3) uneconomical, spoil communal feeling and equality among students. Space needed for tables in corners (—hatching): 5900 x 2550)/12 = 1.25 m2. Space/student required with all passages and appropriate extra space as above: 1.2—1 .3 m2. Seating also —p202—4; snack bars —p205 206 Circulation of diners should be 1-way only: can be achieved by correct disposition of tables and siting of columns at corners of tables to avoid waste of seating space —*(4). Kitchen, servery (service) and sto area between 40—50% of refectory; food preparation 20% of kitchen. Servery area for cafeteria service up to 20% kitchen area. Desirable design on 1 level with convenient stores delivery: avoid staircases and elevators if possible. Kitchen should be big enough for work in uninterrupted sequence without opposing traffic flows from sto to servery. Sto at start of circulation followed by food preparation tables, sinks and eqp including area for pastry making, thence to cookers, ovens and boilers, then to warm cupboards and servery. Provide pot-wash near to cooking area. Off for chief chef should be positioned to provide supervision of stores and delivery points and also whole kitchen area. Crockery should be stored in servery area and after use go by trolleys (carts), dishwashers and drying cabinets back to servery. Good ventilating system required to draw air from dining areas and kitchen and avoiding flow of air from kitchen to dining area. Restaurant kitchens —'p213--.Bib217 Sanitary (USA: check applicable codes and standards): depending on location and proximity to other bldg should be provided next to dining rm; if already available nearby suggested provision: 1 wc/100 males, plus 1/250 males, 1 urinal/25 males; 2 wc/100 female plus 1/100; 1 wash basin/50 P. Finishes: materials should be durable and require little maintenance. Colleges references; —Bibliographyentries039040041 063096097113114147168176 200217226261 377413437441 446472476485526556569581 612629630652 4501 40O1 ________ ?It' I ILl [TT 30)1 L______J ________ 3600 ;ood 2400—f 1 Long tables with free standing benches 500 12300 - l5ool u5 2 Long tables with chairs 450 450 3650 150—200,. •.. ,-..___t Jo[ 50200o .1 70 3 Table with chairs at end good arrangement of supports without loss of space for dining halls 4400—4600 4 Space saving arrangement of supports 5 Integrated refectory services St Catherine College Cambridge England Arch Arrte Jacobsen
Community 143 Youth hostels Often conversions of existing bldg both because of shortage of money and because often in aesthetically sensitive surroundings; therefore Youth Hostels Association (YHA) reluctant lay down definitive plans for typical hostels. Nevertheless specifications and requirements particular and detailed, specially since tightening of fire reg —a(1). In UK DES has also requirements for hostels for which it provides funds: more onerous on questions of space. Bed spaces 3.1 m2 floor ar/P in dormitories 1 wc/1O bed spaces 1 hb/6 bed spaces 1 b or sho/20 bed spaces For purpose of computing floor area DES disallows any part of floor over which ceilings less than 2100 high. YHA has lower standards, depending on grade of hostel: simple or standard. Simple (need not have resident warden) mm 2.04 m2/bed space; standard (must have resident warden living within curtilage of hostel at all times when open to members) for dormitories mm 2.32 m2/bed space, recommended 2.78 m2. As double bunks normally used this means 6.31 m2/bunk if DES standards to be met. Dormitories YHA, ruling body for hostels in England and Wales (Scottish YHA has similar standards), lays down all hostels must have separate dormitories for men and women, with separate access. Layout of dormitories should be such that can be used by either sex as bookings demand: means that either sex must be able to reach appropriate lavatory. Most compact solution block of intercommunicating rm with appropriate door locked between sexes. YHA aims to switch to arrangement in many continental hostels with 4-bed dormitories, with sanitary accn reached from common corridor, motel style. DES pressing for degree of privacy in washing arrangements for women, satisfied by arranging washbasins in own cubicle with curtain at entrance. Hosteller's amenities As hostels closed during day arriving members need luggage rm to leave gear without having access to rest of hostel; may be combined with drying rm, where hostellers take off outer clothing before booking in at reception desk. To allow to cook own meals members' kitchen provided in all hostels, in addition to kitchen of warden who will also cook for hostellers. Members' kitchens have combined double cooking rings and burners and grill units, fuelled by propane gas where mains services not available. Locker space also required, and also washing up space, in addition to that intended for those hostellers who take warden's meals who are required to wash up. Warden's quarters Hostels with more than 40 beds usually administered by married couples, possibly with children who will need living quarters. Largest hostels will have assistant wardens, provided with own sitting rm, staff dining rm, kitchens and recreation rm. In larger hostels chief warden's quarters should be in form of selfcontained house or flat, with 3 bedr, bathr, kitchen, dining rm and sitting rm. In these circumstances hostellers' accn should never be over or under warden's. Fire safety YHA increasingly concerned with application of more stringent standards of fire safety to both new and existing hostels. Sources of danger have been identified as primarily: interference with stoves or heaters, particularly in drying rm; el or gas faults; smoking; misuse of cooking stoves in members' kitchens. Provision of means of escape in old bldg difficult. Fr required for protected staircases difficult provide in bldg with timber floors. In smaller hostels, akin to domestic houses, distances travelled on fire escape routes not normally long enough to contravene reg. Generally 18 m travel distance to place of safety considered max where floors timber, or 30 m where non-combustible. Mm of 2 staircases normally required, in such positions that no person on any floor has to go further than max travel distance to reach staircases or other point of access to place of safety. 1 YHA schedule of accn for 50-B hostel place arm2 Comment entrance hall 14 with bench & shoe rack off/reception/shop 11 hatch to entrance ha, reasonably close to warden's k drying rm 14 preferably accessible from entrance ha without passing through principal rm: with racks or hangers heated luggage rm 14 if combined with drying rm, laundries & wc 14—1 8.5 m2 each common rm 18.5—23 dining rm 46.5 or 0.7—0.9 m2/P member's k 16 with direct access as possible to dr warden's k 16—23 if possible with hatch & door combined for direct service to dr: skin k preferred to separate sd; access to dustbtns Ia 9.3 each Wash-up 11 with 1 or 2 sk; table space for dirty crockery; easy access from dr; if possible reasonable access to warden's k for return of crockery wardens sitr 14 layout of these will depend usually upon Warden,s bedr balance of convenience, privacy, wardens 2nd bedr as ect warden's 3rd bedr 7.5 wardens bathr 3.25 dormitories 158—167 ,e3.16/P wc for hosfellers not less than 5, for warden 1 washing accn for each sex 1 washrm with b (separated by partitions) or sho, 1 footbath, basins to DES standards airing cpd 1 for warden's use blanket sto 3.75 warmed cycle sto 28 for about 30 cycles, preferably in racks: 1 machine/305 note: floor ar intended as rtiin desirable but in alterations much will depend on existing bldg lighting plant gar & dustbins solid tuel cycles it . & tuei worishop r drying rm ' mess wardens blanket Ihot water entrance ha I men s I waslrn, L bathr Sb boilerl dOnniitorylleSl I 11 .1 , I wa dens a reception common/ - bedr , drysto ofl&shop dui, , dormitoryliesi doflTiitorylieS) I ' womens J wardens - wardens k ro' members k I wash-up 2 Schematic layout for 1 -storey youth hostel 3 Youth hostel converted from existing house by YHA: a ground floor b 1st floor
144 Community Youth hostels 2 Typical sleeping rm; mm ar between skirtings, 4-bed 16 m2 (1 bed 4 m'), 8-bed 16m2(1 bed 2 m2), 10-bed 30 m2 (1 bed3 m2), 20-bed 30 m2 (1 bed 1.5 m2); in large dormitories 32 beds 32.7 m' (1 bed 1.02 m2) GERMAN STANDARDS Small hostel with dormitory 30—50 beds Standard size 40—i 00 beds Large 100—250 beds Very large 250—600 beds Optimum 120—180 beds, with 400 upper limit. Relate number ot beds to av number visitors; design sleeping lager to cope with peak holiday demand. Siting: open, sheltered from wind, main rm facing SE,S. Space requirement: for standard hostel: in dormitory 2.2—2.8 m2/bed; for 2-tier bunks 1 8—2.0 m2; 1—2 large rm with 20—30 beds, or smaller with 4—12 beds; 8-bed rm much valued. Also rm for sick and accidents 1—2 beds. Av occupation approx 40% girls 6O% boys; sexes either on separate floors or segregated by partitions: some rm arranged to meet different balance up to 50/50. Av rm height 2800, not less than 2500. Dormitory floor area 1.5 m2/bed. Plank beds: single tier 1.2—1.5 m2/bed, 2-tier 1.1 m2/bed. Common rm 1.0—i .5 m2/bed. Meeting/discussion rm sound-proofed and located away from other day rm. Walls preferred wood lined, with rucksack stands and tip-up benches. Kitchens: Both visitors' and warden's kitchens near entrance, preferably with light from 2 sides. Visitors' kitchen fitted for self-catering; in smaller hostels can be in common rm, otherwise separated, also apart from warden's kitchen. Generous provision of cooking eqp; 100-I boiler and sk. Rambler's kitchen big enough for group eat and also sit in winter. Warden's kitchen: glass door or window allows supervision of coming and going; food hatch to common rm. Equipped double sk, low slop sk, 600 deep dresser under windows, lockable draw for money, power points for kitchen appliances; if gas-fitted, low rings for large pans. Sk and crockery cupboards next food hatch and apart from main kitchen: crockery washed by users Larder next kitchen, long narrow and cool Warden's quarters: mm 3 rm each approx 16 m2 including kitchen, which may be on same floor or separate, in which case on ground floor next to reception and with sitting rm, upstairs being 1—2 bedr next girls' section and bathr. Assistants 7 m2/P Entrance sheltered from wind or with porch; convenient approach, shelter canopy, easy for warden watch over. Focus of hostel hall and day rm, divided into noisy (workrm, table tennis, games, dancing), normal (common rm, dining rm), quiet (writing, reading, discussion, office, sleeping): noise control by separation on different floors. Washrooms: area 0.35—0.4 m2/bed; 1 washbasin/4—6 beds; 1 footbath/15 beds, 1 shower/20—40 beds. Showers can be in basement, better next bedr. Ground floor washr for arrivals. Lavatories: 0.3—0.35 m2/bed; 1 wc/i urinal/8—iO boys; 1 wc/6—8 girls: lower proportion in larger hostels 3 Large hostel in Germany Arch Lauterbach a d — 4750 —I F— 5000 —H 8600 — 3800 —f- -——t 3800 — T __________ r..s—..-. __________ \v ______ ______ C, ot ______ ______ o. 0 ________ 10 I 0 C, J 00 f0 0 0 U, — 2800 —4 Laundry if possible related bathr, showers and heating; in large hostels machines and spin driers. Ancillary rooms: sto for packs, bicycles, sports gear; drying rm; shoe cleaning; utility rm for hostel eqp, first-aid box; dark rm in larger hostels; warden's workshop. Construction: suiting environment; resistant rough treatment; stone and timber mainly, mm plaster.
Community 145 Libraries INTRODUCTION Essential that close rapport be established between librarian and architect; for largest schemes library consultant should be employed. Types Community: primarily lending books to adults and children and with general reference section. Current trend in UK towards larger central libraries with branch satellites; rural areas often served by mobile units. Specialised: primarily used for reference, with small loan section. National university: used for reference and research; continually growing collections. See also school media centres —*pl 29, hospital libraries —*pl 77. Increasing literacy and leisure time plus information explosion' make it important to plan for max flexibility and for future expansion. New techniques are changing methods of control/indexing/retrieval. PATTERN 3 main elements, materials, readers, staff, are related in varying ways depending on organisation policy: eg community, school and hospital libraries require predominantly 'open access', ie readers have direct access to books; catalogue a necessary adjunct. At times large numbers of people circulate among spread-out shelving units and are attracted to browse. Larger libraries including universities and colleges concentrate sto in 'open stack' and put reading spaces nearby rather than amongst shelving. Formal arrangement of this often used in USA. Alternative 'closed acess' allows no contact between readers and books except through staff via catalogue. This method used for major sto in national, large city and county reference collections, for rare and valuable books and as 'back-up' sto in any library: 'closed stack'. Specialised/large libraries may have separate subject dept each with enquiry service; catalogue should remain centralised unless computer based. Reference and loan section catalogues may be divided. SPACE STANDARDS Appreciable differences to be found among national and international authorities. Following generally based on IFLA standards: allocation percentage of total ar adult lending reference children circulation/ services! ancillaries 27 (up to 40 in small units) 20 13 (maxar 150m2) 40 (about half for staff rm) in small libraries children's % ar should increase & reference decrease Adult lending population served total vol floor ar in m2 3000 5000 4000 4000 100 100 10000 6000 100 20000 12000 180 40000 24000 360 60000 24000 360 60000 36000 540 80000 44000 660 100000 50000 750 Children open access accn; 15 m2/ l000vol(butminar 100 m2); includes local circulation, catalogues, staff counters, informal seats tor browsing at 1/1000 population, some display eqp Floor ar 75—1 00 m2 for populations up to 10000, and 100—1 05 m2 for 10000 to 20000 people. Basis as for adults (see above); but does not include space for study/talks/story hours'. Separate entrance sometimes provided: but control becomes difficult. Reference Allow 10 m2!1 000 vol as less need for generous circulation. 1 study space of 2.32 m2/1 000 population, with some degree of privacy to avoid distraction; these figures will cover any staff desks required. None of the adult, children or reference figures include provision for periodicals, sf0 of audio-visual materials. population served allowance per 1 000 population Figures based on surveys, but can be useful check; include all general but not indirect services (meeting rrn, lecture & exhibition spacesl Community libraries '10000 to 20000 20000 to 35000 35000 to 65000 65000 to 100000 over 100000 42 m2 total floor ar 39 35 31 28 1 Relationships 2 Small branch lib, Worcester England, 98 m2 5500 vol Arch T Lewis
146 Community Libraries ENTRANCE Community libraries should clearly declare bldg function, and be welcoming. Lobby should reduce entry of noise/draughts. Provide visual stimulation here. Adequate control needed to prevent high losses of books etc through exit: some have had to use turnstiles or electronic detectors. Remember needs of disabled people (ramps/elevator! escalator —.p85—7 407 408 412). Should lead to control/guide area —*below, with display en route. CONTROL AREA Close to or within sight of bldg entrance, and with space to absorb congestion at peak hours, but located to allow max visibility for supervision. Function: to register new readers, issue and receive loan books, deal with reservations and fines. In small libraries also handles reader's enquiries —(1 )—(3). GUIDE AREA Card index/book sheaves/computer print-out books, located near control or enquiry, en route to all dept served, also close to catalogue work area. If card index, allow say 12 m2 covering 36000 vol. ENQUIRY DESK Near catalogue guide and bibliographies. Can help to share supervision with control. MATERIALS Books are, and will continue to be, primary material. Space may also be required for: newspapers and periodicals, discs, tapes and music scores, microfilms, maps and pictures; there may be more to add in future: flexibility of layout necessary. Shelving units Most widely used type is metal shelving, individually adjustable, single sided (along walls) and double sided (island). Unit height 2000 (loan area), 1 500 (children's area), 2300 (bookstack areas). Shelf depth 200—300 (children's books), 200 (fiction, literature, history, politics, economics, law), 300 (scientific, technical, med). Width of unit generally 900 in UK and USA. Main routes in open access' areas 1 800 clear width, and minor routes 1 200. Book stacks Optimum length of shelving 6 units (5400) to max 8 units (7200) but 4 units (3600) where accessible only from 1 end. Centres of islands where open stack' are 1 280—1 520 (gives about 164 vol/rn2); where 'closed stack' centres are 1 060—1 280 (gives 200—215 vol/rn2). Choice between these limits depends on selection of shelf depths and aisle widths. Derivations from stack centre figures will give choice of economic structural grid dimensions at centres of 5400,6000, 6850, 7310,7620, 7750 and 8350. Sub-divisions of these figures will relate-windows, roof lights, fixed elements, ventilation and lighting. Optimum column sizes should be contained within 450 x 450 less finishes and tolerances, clear ceiling height approx 2400. Load-bearing stack units no longer favoured. Multi-floor 'closed stacks' inhibit flexibility and require book hoist with staff captive on each floor. Large area stack more flexible; max horizontal distance from bookshelf to exit or book elevator approx 33 m: may need mech conveyors. Variation for 'closed stack' sto: compact moveable shelving, of which most common is 'right angle roller' type. Saves 5O% of floor space compared with static units but expensive and creates extra floor loading. Space saving of 40% if aisles in static shelving were reduced from 900 to 550 wide. Consider dividing into fr compartments of about 450 m2. Use temp or smoke detectors, not sprinkler system (causes more damage than fire). Reading/study Work table of 900 x 600/reader who should sit facing low screen possibly with built- in light. Student should have 2.32 m2 (which includes circulation space), screened on 3 sides (open carrel); research worker 3.0 m2 or more screened on 4 sides (enclosed carrel). Aim give sufficient privacy for mental concentration yet open enough to know if space occupied and not misused. Lockable cupboards where books reserved there for periods. In community libraries trend away from formal reading rm towards small scattered alcoves and nooks. In university libraries either large reading rm separated from books stacks or, more commonly in UK, reading areas round perimeter of stack areas, with further seating within stacks. returned P4,, out TuII 'I < 'I '1 , ,' I I 1'ir, 1 Small lib, staff of 1; snag: cross circulation 2 Island control, 1 staff at off-peak; snag: separation from other staff ar returned I out boOks TJ I )1r1 / II I I / I ' (i__i 3 Large lib, can adjoin other staff work ar; snag: mm 2 staff all times 4 Metropolitan Toronto lib, largest public in Canada, houses over 1.25 million books, one third on display; space for over 800 readers to study mostly in ar with some natural light key 1 information 2 gailery 3 synthesis 4 eritended hours reading 5 metro information services 6 newspapers 7 snacics 8 rneeflng 9 sto 10 audio visual services 11 general reference & information centre l2circuiation 13 him stack l4graphics lsbibhographicai centre 16 senidEng & receiving
Community 147 Libraries WORK AREAS Unpacking and despatch, accessions and cataloguing, binding and repairs, photocopying and typing Offices Staff rest rm, lockers, lavatories Mobile lending service: weather protected off loading, vehicle garaging, sto for book stock ANCILLARIES Study rm for reference materials Typing/photocpy rm Projection for slides, cine film, microfilm Exhibition space, chair sf0, rm for group meetings Theatre (film, lecture, music) 2 University lib en USA Arch Curtis & Davis Junior activity areas, group projects, story telling Cloakrooms Lavatories (locate to avoid use by general public) Telephones FLEXIBILITY Larger the library greater the need for freedom of future change with interchangeability of major stack areas, reading areas, staff areas. Fixed elements (lavatories, staircases, major services etc) should be grouped. Best if floors can carry stack loading anywhere. Consider future expansion and possible effect on primary bldg. Partitions should be removable. In medium and small community libraries some flexibility desirable (avoid built-in' fittings); but designer should beware lack of acoustic separation and loss of identify for areas of different function and mood. Consider changes of level. FINISHES & SERVICES Carpet general floor areas except stack and work areas; carpet or resilient flooring staff side of control; carpet all steps and stairs in quiet areas; sound absorbent ceilings to all areas. Pale colour floor in stack to reflect light to books on lowest shelves. Book spines highly decorative: for walls and columns consider natural wood/fabric/quiet paint colours. Underfloor coil or ducted warm air heating; at least 3 air changes/hr. For older books and manuscripts hum controlled to 55%. In reading areas give temp of 20—22°C, USA: 18°C winter 26°C summer; but lending dept can be lower as most people wear outdoor clothes (add local heat in control and other work areas). In larger bldg provide air conditioning at outset; or at least plan for future installation, especially for rare or valuable collections (contents of libraries often cost more than bldg itself). Air conditioning standard in USA. Avoid entry of direct sunlight; minimise solar heatgain (unless can be used for heating). Lighting by fluorescent tubes generally but additional tungsten lighting to indicate changes of function/environment and to add sparkle and interest. Emergency lighting also required —Bib1 12. Artificial lighting en lux—°p2 25: control/enquiry 600 lx, reading tables 400 Ix in lending, but 600 lx in reference, book stacks 100 Ix on vertical surfaces, cataloguing and work rrn 400 Ix. Shelf units in lending areas need special measures: consider illuminated canopy projecting about 500 from top of unit with sockets served by underfloor duct distribution. Mm DF —p1 727—9 1 0% with reflectance of 80% (walls and ceilings) and 30% (floors and furniture). 1 Citybranchlib, Durham England, 496 m2 17000 vol Arch A W Gelson
148 Community Libraries key 1 entrance 2 cIa 3 wc 4 elevator 5 photocopy 6 catalogue 7 issuedesk 8 carrels 9 seminars 10 reference inquiries 11 courtyard 12 cataloguing 13 subject inquiries 14 off 15 librarian 16 deputy librsrian 17 despatch 18 machine rrn 19 stsffrm 20 book stacks 21 escape from floor above 22 escape stair 23void ite 13 jfl —42 1sLllhI1LJ ...HTr\.l 1 Nathan Marsh Pusey lib Cambridge Massachusetts USA, an underground sub-dMsion which adds over 8000 m2 to Harvard College lib, appears from outside as slanting grass-covered embankment; lawn, trees, shrubs grow in stone-rimmed earth platform which forms roof a level 1 b level 2 c level 3 Arch Hugh Stubbins & Associates 0 10 20 30 m do ro don 2 Polytechnic lib Portsmouth England provides sto for more than 320000 volumes & 3000 current journals on open access with reading accn for 500 students a second floor b first floor c ground floor Arch Ahrends Burton & Koralek Libraries references —*Bibliography entries 065 073 314 323 353 399 437 455 471 472 474 476622625641 652 EXAMPLES a r p. ft,, if ct 4+4P I = ==
HEALTH SERVICES STRUCTURE Community 149 Hospitals Role and relationship to client of architect in designing for health care services affected by national differences in health care structure: wholly state organised, provided by private resources or organisations or community, or mixed. In UK, though some hospitals, homes and clinics (and local family practice) still private, by far greater part, forming bulk of medicoarchitectural practice, now crown property administered by National Health Service (NHS). Under direction Dept of Health & Social Service (DHSS) or Scottish Home & Health Dept service organised into 3 tiers; regional, area and health districts. Broad planning, design and construction new bldg falls to regional authorities (RHA: in Scotland area health boards) while health districts (HD) serving 100000—500000 population have immediate control individual hospitals, clinics and health centres (HC). NHS in England to be restructured 1982 to only 2 tiers: existing RHAs and new District Health Authorities (DHA). Traditionally in USA health care industry much more varied with health services provided by private, educational and religious sources, community, state and federal bodies. More recently position modified by National Health Planning & Resources Development Act 1974 which greatly increased influence of federal agencies, providing for national guidelines for health planning and for setting up in each state Health Service Areas and Health System Agencies: as result architects's client more likely be state agency than individual institution. Despite these differences, and with variations of emphasis, structure of health services in industrial countries essentially similar. Major elements: Ambulant patient care: exemplified by group practice or medical office bldg, local or community clinics, health centres (HC), forming first contact between medical care and patient. Small hospitals: range from 10—15 beds (UK 'cottage hospitals') upto 100 beds, offering basic inpatient services. In UK most private hospitals fall within this class. Community hospitals (UK District General Hospitals (DGH)): mediumsized to large with 200—600 inpatient beds and most or all major diagnostic and treatment specialties. Also provide some teaching for med, nursing and para-med staff. Also provide specialist support for HC—4p1 81. Tertiary or teaching hospitals: usually have 600—1 000 beds, house not only all basic services but sophisticated specialties. Most provide teaching for med students, nursing and para-med staff and post-graduate training and research. Long stay: for elderly, chronically sick, children, psychiatric patients and some other special purposes p158 162—3 164. In relation to all these, continuing change of emphasis; general trend now shorter stay in hospitals, increase in specialist dept and services, greater stress on outpatient treatment and ambulant care, and development of such local services as health centres and clinics. In many developing countries pattern and order of priority different, with greater stress on provision of local units for essential preventive medicine campaigns and techniques. Building regulations Whereas in UK national bldg reg apply to new and upgraded health bldg in USA federal, state and local codes and standards must be consulted. INFORMATION SOURCES In UK DHSS provides design information on specific areas, services and eqp: published as Design Guides; Building Notes (HBN), Equipment Notes (HEN) and Technical Memoranda (HTM); tendency now to provide more comprehensive and detailed information on Activity Data Sheets (ADB). Known as 'Red Pack', as yet incomplete, ADB sheets contained in 8 volumes divided into categories: 'A' describe activity space and list eqp required, together with appropriate physical and environmental standards; 'B' contain diagrams of individual pieces of eqp. 'A' sheets offer choice: decision rests with planning team. Sheets not computerised, have to be collated manually. Other material is available from such sources as King Edward VII Fund for Hospitals in London, Nuffield Foundation, and SHHD and Central Services Agency (CSA); former Scottish Hospital Centre (SHC) produced small practical information sheets based on full-sized mockups of hospital rm. RHA, Welsh Technical Service and DHSS(NI) also produce guidance material. In USA broad range of material, less organised, available. Sources: Robert Wood Johnson Foundation (Princeton NJ), sponsors studies on ambulatory care; Assistant Secretary for Health, Dept of Health & Human Services (Washington DC) for enquiries on all aspects of health services planning; Kellog Foundation (Battle Creek Mich); American Hospital Association (Chicago Ill) has extensive reference services; National Technical Information Services (Springfield Va). PLANNING & DESIGN Hospitals an amalgam of components, some simple, some extremely complex: each has time scale which covers useful design life, ie before it needs either major alterations or replacement. By careful planning and design components with similar characteristics can be grouped together so as to be adjacent to both those they serve and those with similar structural and service characteristics and life spans. Large or medium hospital complex includes not only patient accn and medical/technical installations but large admin section —p179—80, electro-mech plant and engineering services, laboratories and pharmacy —p1 76 177, library p177, industrial installations for food services and laundry —p1 80, supply, service and disposal (sometimes in separate complex), lecture halls, staff hostels and restaurants, car parks. Hospital essentially divided into 2 main units: inpatient care and outpatient care; further essential units; diagnosis and treatment, admin; frequent additional unit: education and research. In early planning relationship between these significant; diagnosis and treatment appears as linking function —(1)(2). Ideally these would all occur on 1 plane; however much site and other organisational factors impose multi-storey design ease of lateral movement remains prime consideration. Before designer puts pen to paper brief must be prepared explaining operational policies of hospital, with description of activities to be carried out and resources required to do this efficiently. Successful design relies on effective and detailed brief: preparation must be joint venture between hospital users and architect with his design team. 2 Hospital sectors diagram imposed on outline of New York USA Hospital: d & t = diagnosis & treatment 1 Hospital sectors: diagram of relationships
150 Community Hos pita/s Key to 1 2 3: 1 main entrance 2 industrial 3 A & E 4 pharmacy 5 nonresident staff 6 geriatric day P 7 physical med 8 psychiatric day P 9 mortuary 10k 11 residences 12 parking l3wards l4acbi,in 15x-ray 16 outpatients 17 operating theatres 18 isolation MODULAR DESIGN Both in USA and UK pressure to contain costs encourages use of modular systems design —(1 )—(4). DHHS in UK sponsored range of standard designs for whole hospital: 'Harness' method Range of dept based on common design module of 15 m selected as required to meet operational needs and grouped in correct functional relationship to Harness zone' of communications and services. 'Nucleus' Evolved from Harness, Nucleus provides initial 300-bed serviced unit within phased development. 'Best buy' Standard hospital design providing complete package for 600-bed DGH. TIME SCALES FOR HOSPITAL PLANNING Multi-professional project teams make lengthy briefing, feasibility and sketch design stages inevitable; inception of project to commissioning can take 10—20 years: as result many new hospitals considered by users outdated. To shorten pre-contract stage as much as possible architect should produce carefully prepared time-scale networks and have these agreed by team before work started. Once bldg handed over users should be given complete commissioning manual containing description of how bldg intended be used. Instructions should be given for use and maintenance; where possible full manufacturers' information should be included. Manual should be compiled as work proceeds; this can do much to accelerate programme and reduce criticisms made by users. •SS... 1 Typical harness' development plan for DGH 2 a & b Typical DGH: York England District Hospital 800-B Arch Uewellyn-Davies Weeks Forestier-Walker & Bor + YRHA phase 1 (nucleus) rn 1 754 El LJJJ ground floor 16 6 3 Typical 'nucleus' DGH: Maidstone England District Hospital Arch Powell, Moya & partners + SETRHA 4 a Diagram of 16 modular units with air ducts & el/mech service shafts for Armstrong Hospital Kittaning Pa USA b 1 modular unit with el/rnech service shaft
Community 151 Hospitals MEANS OF ESCAPE, FIRE PROTECTION, HAZARDOUS MATERIALS Most bldg reg contain clauses on mm allowable distances between adjacent bldg and type of construction acceptable to resist fire for given periods of time; some state distances and conditions for escape routes. Up to 2 hours needed evacuate 600 patients from 2-storey, 4 hours from 11 -storey bldg: exhausting exercise for rescuers. All health bldg which contain high proportion of bedfast, disabled and confused patients should below rise, preferably with patients restricted to ground and first floors. High rise bldg should be confined to sites where no other solution possible. Because of their special problems health bldg in UK now have own more stringent fire safety measures based on fr compartments; system makes possible move patients short distances, if necessary in beds, to section sealed off by fire door from smoke or fire in adjoining section. Design guidance on size of fire compartments and sub-compartments, together with max acceptable lengths of escape routes in wards, operating theatres, lab etc, can be found in official literature (—Bib21 6218219). As general guide following apply: Are compartments—.(1)(2)(3)(4) UK reg (USA —p1 52): 1 -storey bldg must not exceed 3000 m2 Multi-storey bldg must not exceed 2000 m2 Horizontal distance to alternative routes must not exceed 64 m Horizontal distance in single direction to exit must not exceed 15 m Travel distance within escape stairway must not exceed 45 m along going Fire sub-compartments (patient areas) Floor area must not exceed 750 m2 Horizontal distance to alternative routes must not exceed 32 m Horizontal distance to single directional exit must not exceed 15 m Max occupancy 40 patients Hazardous materials Some eqp and substances used in examining, diagnosing and treating patients radioactive, explosive or highly inflammable. Take every care check that where these substances used design, construction, detailing and service installations comply with specific statutes and reg. On fire safely and hazardous materials consult official publications and health authority concerned before making any decisions. 6 sub-compartments ff1 Ii exit I I 750m2 I 1 exit 750m2 750m2 I 0 II I 0 II I 2 compartments 1 Compartments & sub-compartments protected route f 32m 32m 1 - ,-= =-, = — ' dual direction single direction 0 in s d — L64 m —— P position 2 Travel distances for wards wards 3 m I others 1 m handrail T doors to open in protected lo j j tostoreys l 950mm1 '1 95omin'T' above 18m 3 Escape stair dimensions 45 m max travel .</iistance along ' 2 m clear -- - - -- 726 forO—25P 800 for 26—60 P 1 too Lfor61_2o0P sao Jfor2oi+P& perlOOP Tdoloors 4 Vertical travel distance on — 5 Size of escape doors escape stairs i u I dl: for double car banks ! • ld2:forsinglecarbank j B elevators I dl = 5/2—3 x lift car depth P elevators d2 = 3/2 x lift car depth d3 = determined by traffic peak 6 Bed elevators & P elevators 7 Bed elevator: detail 2670 I dlord2 I cardeptti 'I' 1'
152 Community Hos pita/s 1 Travel distance to exits * these distances or ar may vary in different bldg codes & can frequently be lengthened in bldg equipped with automatic fire extinguishing systems 2 Corr walls: corr shall be separated from all other ar by partitions which shall extend full Ii from floor to under side of roof or floor slab above; vision panels in corr walls permitted with wire glass: size of panels limited unless whole bldg protected by automatic extinguishing system; interior stud partitions must be fire stopped to prevent fire spread both horizontally & vertically — corr must provide access to at least 2 exits larger rm more than 92m2* require 2 exits not more than 9000* 3 Arrangement of exits: all patient sleeping rm shall have exit door leading directly to exit corr which shall be at least 2440 win hospitals; rm larger than 93 m shall have at least 2 remote exits; exit corr shall lead to at least 2 approved exits; dead end corr shall not exceed 9000 * these distances or ar may vary in different bldg codes; travel distances can frequently be lengthened in bldg equipped with automatic fire extinguishing systems MEANS OF ESCAPE (cont) Typical USA requirements given —(1)—(4). For each design project necessary consult details of relevant state and local codes. 4 Subdivision of floors: floors used for sleeping ortreatment of more than 50 patients must be sub-dMded by smoke partitions and shall be divided into compartments not more than 2090 m2 in ar; max I or w of compartments 45.7 m*; corr doors in smoke partititions shall be opposite swinging pair; doors shall have wire glass vision panels; ducts which penetrate smoke barriers shall must be fire stopped to prevent fire spread both horizontally & vertically have dampers * these distances or ar may vary in different bldg codes; travel distances can frequently be lengthened in bldg equipped with automatic fire extinguishing systems 5 Types of fire detectors a photoelectric respond to visible smoke, work on obstruction principle (rising smoke tends obscure light beam & sounds alarm) b thermal respond to heat energy c infra-red respond to flame d ionisation respond to invisible combustion products
DESIGN/BUILDING CONFIGURATIONS Community 153 Hospitals 1 Relationships between major dept at proposed medical centre Tucson USA Arch Perkins & Will Ideal hospital design combines clear and simple traffic configuration with ability expand bed units and service base in future, growth and change within hospital structure being continuous. Beds do not always increase in same ratio as service programmes but each must contain master plan of direction. Bldg do not occupy major part hospital grounds; parking (1 I/2_2 car/B) and multiple entry create larger land use. Broadly hospital bldg made up of 2 parts: base and bed configurations. Base concepts Base services fall into 2 categories: ancillary services orientated to patient care and service dept such as sto, laundry, dietary, housekeeping. These 2 elements can be combined in 1 base structure or be independent. Different fire-rated enclosures may determine approach. Bed concepts Design should meet nursing concept of optimum organisation and staffing. B/staffing team usually 20—30 patients. Mix of private and semi-private rm also contributes to bed design. Mm USA Health Dept standards also have controlling effect. Specialty and intensive care units have lower bed ratio; long term may contain more than 30 beds. Modular nature of bed design may conflict with structure of base. Concept of using long span trusses as mech-el route between hospital floors has developed. Question of additional initial cost as against life of bldg flexibility must be considered for each project. By USA standards correct ratio beds to base for community hospital approx 37—46 m2/B for nursing units and 46—56 m2/B for base. Teaching hospital may range up to 140 m2/B, with university programmes and children's hospitals high as 185 m2/B. 2 Master plan Temple University Hospital Philadelphia USA Arch Perkins & Will 3 Relationships between patient care & support services & between bldg & site -. heating&cooling ii;) ;7 datprncessirig .i auxiiiary person neil "'-'J LI \J (I.. 0 100 200 ft nursing units N 30 6o m diagnostic & treatment services (including ciincs, etc) [J admit, & pubiic an [j support services 0 7 14 21 28m 25 50 75 lOOft
154 Community Hospitals WARD DESIGN: GENERAL Outlooks on ward sizes subject rapid change. Main recent trend away from classical ward types (eg 'Nightingale': 12-B open ward with nurses desk at 1 end; 'Rigs': 24-B with nursing rm outside ward, beds set in clusters); preference now for 2—4 B. Despite this strong preference still controversial: very small wards give privacy and in theory more personal attention but can also be lonely, less often visited; ie society and staff supervision possibly better in larger ward. Patients need audio and visual privacy during med visits. Background noise and bed curtains provide some in large ward but lights disturb at night; small wards peaceful for resting patient but do not provide audio-privacy. In USA most codes now give max 4-B/rm and design standards usually followed maintain mix of 2-B and 1-B. In UK small rm also common; but wards may consist of mix of different size rm —acute wards below. Av stay in hospital for acute med or surgery has fallen, eg: major surgery 10—12 days, minor 2—3 days, max 6 weeks (mainly orthopedic). Wards for these purposes therefore designed for max efficiency of staff working. For physically and mentally handicapped and elderly — 'long stay' — ward design more domestic and social —pl 58 162 163. Key problem of design for efficient ward system: relationship of nurse working rm to patientrm. Basic concept —3(1). WARD DESIGN: ACUTE Acute wards contain 24—30 beds; where possible should be linked together to form admin unit of 2 or 4 wards, which also enables such service as day areas, doctors rm, disposal rm, sto etc be shared between 2 wards; but check against fire reg before design decision made. Possible breakdown of bed areas for 28-bed mixed sex wards include: 3 x 8-B rm + 4 x 1-B rm 4 x 6-B rm + 4 x 1-B rm 2x 12-Brm+4x 1-Brm Most acute med and surgical wards can be mixed-sex, argument being that it increases bed occupancy. 1-B wards needed maintain occupancy at max of 85% or above: 1-B also required for patients liable to infection, or to infect others, those seriously ill or dying and those likely to disturb others. Mixed-sex ward may not be acceptable to all users: check before designing on this basis. Walking distance: keep walking distances short as possible for nurses and ambulant patient. Max distance from bed to wc 12 m and from nurse working rm to furthest bed approx 20 m. Observation: continuous observation of patient by staff essential part of nursing care: during day achieved mainly in course of walking from 1 duty to another, at night from nurses station. Good design aim: 50% of beds to be visible from nurses station. Patients gain confidence from seeing staff at work, dead-leg wards not popular for this reason; if staff have no duty perform less likely visit ward. Control: patients, particularly children, adolescents and confused, need to be controlled; dayr must not be too isolated from rest of ward. Mixed-sex wards have own control problems. Staff need to control visitors and check that they do not overtire patients. Noise: problem in large open areas; telephones and other el and mech eqp can be noisier than acceptable. Design for 40—45 dB by day and 35—40 dB at night in multi-B wards; 1-B wards should be 35—40 dB at all times. Courtyard designs can create problems of noise from adjacent windows to different rm. Daylight & glare windows —p4O3—6 should not cause glare —p32 398 in bedfast patients' eyes; beds should be parallel to windows unless brise-soleil, external or between-glass blinds or similar devices fitted. Windows design important: confused patients may try get out; all opening lights should have device restricting accessible opening to 100. Ventilation: mech ventilation often noisy and unsatisfactory, full airconditioning expensive install and run. Normal sites away from air or traffic noise should rely on natural ventilation; 3 beds deep from window max before mech ventilation required. Central work rm require mech ventilation and suffer from heat build-up in summer. Nurse call systems, closed circuit television (CCTV): Devices of various grades of sophistication; all liable to abuse or failure. Seriously ill patients cannot operate call systems therefore unwise rely on these rather than personal observation; acceptable as auxiliary system. 1-Brm multi-B bay (per B) dayr (per B) lockers etc (per B) nurse station clean utility dirty utility & sluice treatment rm assisted bathr sisters rm doctors rm bathr washing & sho compartment wc with hand rinse basin ptr ward k flower bay cleaner sto (inc large eqp) interview rm & overnight stay circulation ar lOOm2 9.3—1 0.0 m2 0.75 m2 0.5—1.0 m2 4.0—10.0 m2 10.2—18.0 m2 14.0—16.0 m2 14.0—1 6.0 m2 10.25—12.0 m2 7.0—9.0 m2 7.0—9.0 m2 7.0m2 2.75 m2 2.0—3.0 m2 4.0—6.0 m2 20.0 m2 2.0—2.5 m2 5.0—8.0 m2 12.0—20.0 m2 10.0—12.0 m2 25%—40% excluding wc & sho depending on amount of day space provided in wards or as separate day space: separate 10.0 m2 extra space for lockers etc depending on position of drug, linen bays etc if separate ar = 9 m + 7 m depending on sto provided for ambulant patients mm for ambulant P max for wheelchair P beverage & snack point only for ward k service ACUTE WARD: SUGGESTED AREAS I ® r • option I nursing : B • sub-station • I_ A control access & egress to unit B access&visualobsefvationtoP C Convenient access to support activities 1 Diagram of nursing/P rm relationship may be shared with another ward depends on ward layout
Community 155 Hospitals 2 Falkirk ward; experimental, resulting from studies carried out by SHHD; built mid-i 950's, 2 x 30 B; first & second floors 3 Typical 'harness' ward; 72-B unit with 3 staff bases 1 wc 2 sho 34-B 4 5-B 5 b 6 treatment 7 base clean utility 8 dirty utility 9 sister 101-B 11 day/dining 12 3-B l3sto 14 visitors 15 supplies BASIC WARD TYPES Linear ward —(1) In past wards designed on linear form: large single space, 20—30 beds supported by nurse working rm at one end, sluices and wc at other, quite often large work table middle of ward. Main ward or wards and majority of spaces naturally lit and ventilated. Observation of patients good; patients had little or no chance of feeling neglected. Background noise problem but to some extent this gave greater privacy than in 4-or 6-B wards. Since 1950's different shapes have been used (also modifications of linear as at Guy's Hospital London). Deep ward or race track —(2) Design concept developed in late 1950's, complete contrast to linear: patients share nothing larger than 4-bed ward. Observation good so long as enough nurses to move round ward. Race track design prevents dead-legs where patients could feel neglected. Background noise reduced but as result audio-privacy for consultations not so good as in large linear. Wards placed on outside walls, naturally lit and ventilated; nurse working rm form central core, need artificial light and mech ventilation. Courtyard plan —(3)(4) Courtyard plan (harness, nucleus —pi50) attempts reduce internal working rm and provide good patient observation. Success of this type depends on amount of daylight available and degree of privacy obtainable. All wards have some daylight but some mech ventilation may be necessary. 5 Typical nursing floor (48-B) Anne Arundel General Hospital Annapolis USA Arch Metcalf & Associates 1 Guy's Hospital London typical ward floor, 2 x 27 B Arch Watkins Gray International centre 0 5 10 15 20m 15 30 45 60 ft 4 Typical 'nucleus' ward, 2 x 28 B -v hr 11 14 H I L1J2 ___ iEJ L 9 Sm 10 20ft
156 Community Hos pita/s 1 4-or 6-B ward, 8.4 m2 & 8 m2/B: optimum privacy, each P having wall on one side; B parallel to window to reduce glare; curtains give each B visual privacy but centre B has less; max 3-B depth before artificial lighting & ventilation required Dbctier :f::f:f:.:.J Dtha 1 LJce L 1 Iii 3200 2 1-B wards suitable for P liable to infection orto infect others: a 13 m2with sho & wc, also suitable for other P needing special attention b 12.34 m2 with we, or could be without we for bedfast P dying, needing special attention or likely to disturb others; NB 1-B wards for senously ill must be close to nurses station NURSE WORKING ROOMS p156—7 show layout, dimensions and eqp required for main nurse working rm in standard ward. Variations in size and shape of rm may be dictated by ward plan, but work pattern and critical clear working spaces round beds and other eqp should be maintained. 4 Dirty utility rm, 14 m°, equipped fordisposable bedpans: if non-disposable used washer replaces destructor, no disposable sto needed 1 rack for bedpan cradles 2 slop sk & drainer 3 bedpan destructor 4 space for disposable bedpan box 5 disposal bag 6 hb unit 7 space for disposable bedpan & urinal boxes 8 space for disposal bags 9 waste disposal bag 10 urine test cabinet 11 sk & work top, cpd under 12 sanichair dangerous drugs & scheduin depenser with drawer towel external [thj E[i I I i Id1! = 450x 450 position of disposal ar adjoining 3 .—, T - • MJ'3 observation 1 window : railfor J el poene T;ine L:I 5400 Sb with drainers paper towels disposal bin 5 Clean utility or preparation rm, 24.3 m2; small dressing trolleys (carts) replace traditional fixed work tops, considered superfluous; linen stored on adjustable shelving & topped up to agreed level; no linen trolley required for clean linen 6 Medicine trolley (cart) chained to wall when not in use 800 mm I 7200 (6-BI 4800 (4-B) T for4-Bwaid a Isliding door b external wet T 2560 c,,l 3 Small ward pantry, 5.5 m: for beverages & snacks only
NURSE WORKING ROOMS 1 Doors & screens in ward corr r -i . - -L I solidorgiazed I panels if required t I_ sohdorglazed panels if required —— I j 700 Ieoo 900 j 900 500 2= - T single-leaf double-leaf 2 Standard door sizes for hospitals: where high/low B used standard 2050 doors Ii enough to allow through B with balkan beams; mm door w for wheelchair 800, preferred 900 3 Fittings in ward corr 4 Mm corr w for manoeuvring B Princess Grace Hospital London Small 136-bed hospital for private patients, majority from overseas. Visiting consultants and surgeons diagnose and treat patients; permanently employed nurses and support staff. Added need to attract patients by providing 1-B wards of domestic character and comfortable proportions (17 m2) with integral bathr, but as with NHS hospitals, prime importance to design best possible environment for diagnosing and treating patients. 5 Princess Grace Hospital 22-B ward unit: private hospital Arch R Seifert & Partners Community 157 Hospitals 2x900 leaves rnanoeuvnng from straighf corr through doorway clock nurse call fire alarm bell indicalor 9 P 1 m 5 3b 5 6Toft
158 Community Hospitals 2 types; for assessment of elderly, for long term care. For assessment patients normally housed in adaptation of standard acute ward within DGH, because access to full diagnostic and treatment services needed. For long-term patients (assessed and found to be in need of long-term care) aim to provide homely environment in which basic nursing care can take place; emphasis on early ambulation and rehabilitation —vpl 62. Often in separate bldg on hospital campus, within easy reach of diagnostic and treatment services. In UK shortage of geriatric beds partially overcome by upgrading some wards in older hospitals (upgrading wards —vpl 65). For details of geriatric bathrandwc—vp163. dothes hooh —B B 1650 shelf a 1100 towefraji D j: 1500 • Phclst980X880 grabriel geriatric b C 100 - — — 685 DATA FOR DESIGNING WARDS: GERIATRIC curtain rail Dedhead ht 1700 bedhead thermometer 14801 — - bectiesd unit oo 1000min med gas outlets curtain on 3 sides of bed B boilers 700 h 2x200 w 200 v——i I ingsFunc I B 4-500- 01.I 1300 1A 1? ti 95Owide 2050+550 for bed stripper 1 Multi-B ward: eqp & fittings in Bar paper towel dispenser suap dispenser .hb — — —— Staff hb c--i_- 230 clearance under tap 1300 I 1300LT#J__ I I 865 i7tlsforchildrenor papersack : — unit in wards, nurse working ar etc 4 Ba hr duct 190v60 clothes hook 1650 grab rid bedpan red 1111111 x330 unnetestcanet bedpan washer -i 'T diet 1100 I1 854 —- 1549 adjustable light I 1200 1800 shed med gases- l 7 nurse call etc receiver 2400 1 6 300 3 Dirtyulilityar dropped front suitable for wtteelchan P 5 Shoar x-ray viewer notice board note takuig desk 4lousIooe 1300 IllOOforseated 1000 viewer 80 1 x300 6 P wa unit (not standard) 7 Nurses station syringe dispenser B Clean utility or preparation ar (dda = Dangerous Drugs Acts)
DHSS standard controlled drug cpd 2 Geriatric assessment ward (upgraded Nightingale ward); one problem of elderly is to remain continent: example shows how walking distance from furthest B reduced from 30 m to 8 m & day arfor rehabilitation, dining & quiet pursuits provided; B reduced from 28 to 22 & wc increased from 4 to 8; day ar 2.252P 11-B 2 multiB rm 3 disposal 5 b (free standing) 6 preparation rm 7 hb 8 sluice 9wc 10k 11 staff clo/wc&hb 12 special bathr/cleansing ar l4eqpsto l5dayar l6quietar 17 dining ar 18 nurses station 19 DSR 22 linen sto 23 wheelchair sto 24 sanichair sto 26 sister 27 staff rm 29 switch gear! calorifiers etc 31 P clothing sto 33 lecture rm 38 sho 39 special couch 42 doctor 44 stainless steel sk with laying shelf 45 lalptr 46 free-standing bidet/wc 4 Orthopedic fracture frame: B may be moved through doors complete with frame DATA FOR DESIGNING WARDS (cont) 580 350 .. Community 159 Hospitals typical bedside lockers high/low B with pull-Out bedstripper 3 KingsFundB:2080x910x380—810h / I '. _______ '4 t IL x 558+230 space Clinimatic disposable bedpan destructor: dry weight 110 kg max capacity 1351 overbed table for high/low B 5 Childrens cot: 1 370 x 760 x 610 + 69ohsides drip stand attachment 1 Typical ward eqp 6 Typical incubator 7 Bassinette for infants 10 3 20 3Dm 60 90ft
160 Community Hospitals 1 Combinedfirststage&deliveryrm, 14.46m2 1 caps&masks 2baby cot 3 tray 4 trolley (cart) 5 single bowl stand 6 scrub—up hb 7 sack & stand 8 heating panel 9 obstetric B 10 chair 11 sliding door 12 writing shelf 13 bedside locker 14 time elapse clock 15 oxygen suction, child 16 sto rack 17 dispensers 18 curtain 19 coat hook 20 spotlight 21 drip pole on wall hook 22 wall thermometer 23 clock 24 observation panel 25 sphygniomanometer 26 oxygen suction, mother 27 bedhead panel 28 cup & flask 29 overbed tray 30 towel rail 31 footstool 32 analgesia trolley 33 overbed light MATERNITY Units normally attached to DGH or community hospital. Allow 0.5 B/ 1 000 total population; 75 beds cater for 2700 deliveries/year, 100 beds for 3600 and 125 for 4500. Maternity clinics include ante-natal, postnatal, baby follow-up and family planning. Most units require normal backup for reception, admin, including records, and provision for education. In USA trend to set delivery suite alongside surgery suite or integrate with it. Delivery suite includes: theatre, abnormal and normal delivery rm and assessment area. For 125 beds allow 17 normal first stage delivery rm, 10 observation beds, 4 abnormal delivery rm and 1 operating theatre. Obstetric theatre suite: theatre (28 m2) with full mech ventilation, hum and cooling control and antistatic flooring, oxygen and nitrous oxide and 2 vacuum points for mother, vacuum and oxygen for baby; scrub and gowning areas (9.5 ml, anaesthetic rm (16.5 m2), recovery beds for 2 patients (25 ml and clean utility (8.5 ml. All delivery rm require pleasant daylit environment with privacy (blinds to windows), good lighting for suturing, sound attenuation, anti-static precautions, med gas, oxygen and vacuum outlets, and mech ventilation with hum and cooling installations. Abnormal delivery rm (24 m2 plus scrub area 1 .5 m2). Normal delivery rm (15 ml: 2 of these should be quiet with blackout eqp. Combined first stage/delivery rm —+(1) enables patient stay in 1 place throughout labour, her first move being to post-natal ward after normal recovery period: provide 1 of these rm to 5 post-natal beds. Assessment area: 20% beds should be in 1-bed wards (13 m2) with oxygen outlet at bedhead, remaining 80% in multi-bed bays (9.5 m2/ bed) with oxygen outlet to each pair of beds. Ancillary accn: sto, milk kitchen (14 ml and flying squad sto (7.5 ml — which may be in accident & emergency dept (A&E). 30-cot special care baby unit (SCBU) attached to this number of beds requires 22 multi-cot bays (4 m2/cot), 7 single-cot rm (5.5 ml and 1 special-cot rm ((7.5 ml; 20 cots considered mm size for viable unit. Entrance to SCBU must include gowning and handwash areas for visitors, and changing accn for staff: female, 11—14 m2 male 7.5 m2. Bedsitting rm for mothers with sho and wc —(2). 2 Mother & child rm, 16.32 m2 1 wa 2 visitor chair 3 window (curtains or blind) 4 mother's bedlamp 5 cantilever table 6 drawer unit under 7mother'sB 8curtaintrack gchild'scot looverbedceilinglight 11 twin socket outlet 12 oxygen & suction 13 locker 14 child chair 15 toy box 16 waste sack 17 hb 18 towel dispenser 19 towel rail 20 shelves 21 wc 22 baby bath 23 mirror 24 glazed panel (with blind or curtains) 25 sliding door 26sho 3 Obstetric dept Easthourne England DGH: A delivery suite B matemity ward 1 wr 2 seminar 3 staff changing: a female b male 4 dayr 5 first stage rm 6 multi-purpose 7 wc 8 b 9 lab 10 abnormal delivery 11 trolley (cart) & wheelchairs 12 ovemight stay 13 dirty utility l4exam l5ptr l6doctor 17 nurses station 18 charge nurse 19 clean supply 20 anaesthetic 510 21 dirty utility 22transferar 234-B 241-B 256-cot 26assistedb 27 dirty linen 286 incubators 29k 30 central milk k 31 demonstration 32 obstetric tutor 33 nurse admin 34 reception 35 sb 36 mobile x-ray 37 1-B toxaemia Arch SETRHA DV1F risi I L L1716 25 1365m2 2671712 21 9 w__ _____ 9 1 18 16 96 9 10 20 30 4pm 64 96 1286
Community 161 Hospitals PAEDIATRIC & CHILDRENS WARDS 1 20-B childrens ward Arch Nuffleld Foundation division for architectural studies 2 West Middlesex Hospital England a paediatric/inf ants ward b paediatric/children's ward A 4-B/4-cot ward Al 4-B — staff B 1-B/i -cot ward C wash/wc D bathr E nurses station F clean utility G treatment rm H dirty utility/sluice I disposal lift J ptr K trolley (cart) bay L sto M 2-B/mother & baby rm Ml clinical mi — staff N sisters rm 0 doctors rm P consult rm 0 secretaries off A playground P1 milk k 01 mothers si R 1 relatives rm S staff do I clinical rm U elevators V paternoster elevators & stairs W play ar X cleaners rm Y classr Z admission rm Arch Robert Matthew Johnson-Marshall 3 Diagnosis centre for school age children, converted from outmoded ar of older hospital in Jersey City USA; existing courtyard used as play rrn & reception ar; sequence of rm provides both range of health tests & educational programme Arch Hillier Group West Middlesex Hospital Both wards —(2a,b) adapted from standard, part of 5-storey high system bldg. Paediatric/children's ward —(2b) contains 2 x 4-B wards, 6 x 1-B wards, 2 with wc and bath attached, and 3 x 2-B wards which can be used either for mother and child or for 2 patients. Classr for children in hospital for several weeks but fit enough attend classes, eg child with broken limb. Away from ward, area with adjacent toy sto where boisterous children encouraged play. Protected open air play area also provided. Paediatric/infants' ward —+(2a) has 8 x 1-cot wards each fitted with baby bath and 4 mother and baby rm each capable of taking full-size bed and child's bed if necessary. Play space provided together with protected open air area. Milk kitchen provides for heated baby feeds and baby bottle washing: daily throughput 240 x 0.25 I milk, of which two-thirds kept under refrigeration; extra sto required to keep milk over public holiday periods. o 3 6 9 12 ,1 ,1rn 9 18 27 36 ft a b
162 Community Hos pita/s LONG STAY WARDS Long stay wards for elderly and infirm must be sited near public transport for easy visiting by relatives, often elderly themselves: need access to diagnostic and treatment services, so wherever possible should be built on same development as DGH (community hospital) or be grouped together to be able to support own services. Patients could easily become institutionalised in wrong environment: accent on self-help and rehabilitation in setting as like home environment as possible without impairing quality of nursing care. Patients require sleeping areas which can identify as own, and must have ready access to personal belongings. Wc and washing places must be near to both sleeping and day areas. Design of day areas should allow patients follow therapeutic routine enabling them care for themselves and if possible return home to receive necessary community care either at day centre or by domiciliary visits. Important provide variety of spaces for social meetings between patients and visitors and between patients, and for small group chats or games or larger group activities (corr alcoves, small separate rm). Dining arrangements also important for providing social and domestic atmosphere. Clear marking of rm, corr, elevators essential; colour coding helps Now few completely bedfast patients needing bedpans and bed baths during day: majority will be taken to wc and bathr even if incapable of attending to themselves —*pl 63(2)—(7). Because incontinence prevalent extra wc required aid training (max distance from furthest bed or corner of day area: 10 m). Where space limited omit treatment rm and replace by cleansing rm with bath or wc each with thermostatically controlled sho handset —*pl 63(2). Wc, sluices and cleansing rm must have efficient mech extract ventilation. Small utility rm with washing machine and clothes drier needed for patients' clothes. Provide extra sto space for wheelchairs, walking aids and sanichairs, and for greater supply of linen, incontinence pads and, where used, disposable bedpans and urinals. Cpd also required for patients' suitcases and clothes not in current use, and for occupational therapy eqp. All floor finishes should be soft, non-slip and washable: plastics flooring with welded joints suitable for wc, bathr and all nurse working areas. Carpets may be used in wards and dayr where number of incontinent patients limited. Patients can be confused and if allowed go outside more easily controlled in courtyards than in open hospital grounds. All doors wide enough for wheelchairs —*p86; fire stop doors should be held in open position by automatic fail-safe devices for easy movement of patients in wheelchairs or using walking aids. Term geriatric —p1 58 generally used to describe those over 65 years who develop several med problems at once and who may also suffer impaired mobility and be incontinent. 3 Genatric Day Hospital Walton on Thames England: 35 P on basis of 5-day week; includes P assessment, med, para-rned, nursing procedures, occupational & physiotherapy, training in aids for disabled & domestic routines 1 main entrance 2 reception 3 do 4 interview 5 speech, dentist, optician, 6 hair, chiropodist 7 sto 8 off 9 individual therapy; physiotherapy duties 10 group therapy; physical exercises ar 11 occupational therapy dr l2court l3dr l4dr&wr l5wr 16k&servery l7dailylMngunitbedr 18 rest 19 b 20 assisted b 21 treatment 22 dirty utility 23 consult/exam 24 staff rest 25 boilers & tanks Arch Derek Stow & Partners Mentally handicapped often also physically handicapped may also be noisy, aggressive, overactive and self destructive. Particularly important that furnishings be soft, spongeable and durable for these patients, and that ceilings have sound absorbent finish. Psychiatric wards —p1 64 Long stay patients highly dependent on staff in cases of emergency: vital fire escape routes be easily identified, fire stop doors have automatic door closers connected alarm system and fabrics and finishes fr. 1 Elevator level coding system using colours & numbers; helpful toP with sensory defects; raised numerals aid near-sighted or blind 2 Mentally handicapped unit, plan of typical villa, Craig Phadng Hospital Inverness Scotland 1 sister 2 visitors 3 P do 4 sto 5 domestic service rm 66-B 74-B 81-B 9wc l0bathr 11 staff wc l2preparation l3linen l4uty l5disposal l6hobbies l7dutyrm 18TV lgdayspace 2Odr 21k 4 Hostel accn for P returning to hospital for rehabilitation courses (amputees & other physically handicapped P) 1 group dayr 2 fire escape stair 3 bathr 4 sh 5 wc 6 wheelchair bay 7 ptr 8 sto 9 doctors rm 10 sister 11 dr 12 duty mi 13 nurses station 14 preparation 15 treatment rm 16 assisted bathr 17 dirty utility rm 18 sluice rm 19 staff wc 20 wr 21 reception 22off 23 porter 24 domestic service rm 251-B 26 large 1-B 274-B 4ft
LIBERTON HOSPITAL —*(1) Geriatric hospital in grounds of existing hospital; has both in and day patients with total 184 beds mainly in 24-B units. Day patients can be examined in 1 of 2 consult/exam rm and have midday meal in dr; share physiotherapy, occupational therapy, dental and hairdressing services with inpatients. Wards contain dining area and 3 separate day spaces, 1 for exercising and 2 for sitting in. Ward block 4-storey ward block: 3 floors 48 beds each, 1 of 40 beds on first floor used for hemiplegic patients. 48-B floors divided into 2 x 24 nursing units, each comprising 3 x 6-B bays, 1 x 4-B bay, 2 x 1-B. Bedside fittings include nurse call, radio and tv controls, bed light and curtains. Each 24-B unit has 2 bathr, 4 wc, clean preparation rm, dirty disposal rm, shares exercise/dr for ambulant patients, and 2 small dayr. Each floor has ward kitchen, med officer's rm and sister's rm. Ground floor Entrance hall with reception counter and general waiting area. Lift hall with nursing and admin offices, hairdressing rm, porter and shop. Occupational and physiotherapy, med social worker, dentist and chiropodist share patient waiting area. Day patients and dr for midday meals served from kitchen which also provides staff meals in small canteen. Consult/exam rm separated from therapeutic/social areas. Community 163 Hospitals: long stay cutacle partition sho curtains impervious wall tinish Tc!_ sho handset 2 Incontinent bathr & wc, 8.6 m2 + 7 m2; may be planned as separate units; required in wards caring for elderly & handicapped where policy of early ambulation coupled with need to extend nursing care to non-bedfast P; both b & wc equipped with low-pressure sho handset to ease problem of cleaning incontinent P; good ventilation required: allow for 6 air changes/hr at peak times 3 Assisted wc a for nonwheelchair P requiring assistance of 2 nurses b for wheelchair P requiring assistance of 2 nurses I!:J!iJ 50 H-i 56 83Vij entrance - j• 63 6J 66 a b EQUIPMENT 0 5 10 15 2am 1 1 I 16 32 48 64 It 1 Liberton Hospital Scotland a first floor geriatric inpatients b ground floor geriatric day P 49 common rm 50 physiotherapy 51 dentist 52 chiropody 53 MD clinic 54 therapist 55 almoner 56 wr 57 hairdressing 58 dark rm 59 consult/exam 60 seminar interview rm 61 med staff 62 lounge 63 canteen 64 dining ar 65 servery 66 trolley (cart) wash 67 pot wash 69 cold sto 70 reception 71 porter 72 admin & nursing staff 73 general off 74 shop 82 bathr 83 occuptional therapy 84 ward ar 85 treatment 86 exercise & dayr 87 doctor 88 sluice floor channel -, L1 -, ___ hooha Ddspos11 fl I laid to hoolrs' ' shj YntSt1 curtain trotley (Th I I sanichairs (cart) ) I trolley rlIr I Li i.—L 3200 , 1300 , 1300 I t hand spray — tagh ptatform 1 980x550 5 T1• Tl b & platform elevator 4 Mobile b elevator U0 1 door I ducttor 'astern a 4—1800---4- 250 1710 b t 2170 It 1800 Di 6 Elevating b 880 7 Fibreglass sitting b: dry weight 52kg; av b 1251
164 Community Hospitals PSYCHIATRIC CENTRES Present trend away from isolated sites for psychiatric hospitals in favour of places allowing easy access for day patients and visitors and enabling inpatients maintain close ties with their community. Community involvement often encouraged in USA both by making appropriate parts of centre available to public, eg gymnasium, children's play rm or craft studio, and by incorporating such amenities as art gallery or public lib. Association with med centre desirable but important psychologically psychiatric centre maintain own identity and character. Environment contributes essentially to therapeutic process. Centre should be noninstitutional as possible consistent with type of patient, need for security, protection from self-injury and vandalism; range from 'open door' to forensic institution for criminally insane. Great size to be avoided; patients should be grouped into units (max 30 P), small enough facilitate development of community spirit (atmosphere nearer college dormitory than hospital). Where climate allows common practice provide residential units in form of cottages in landscaped grounds. Even where restricted site imposes compact bldg form essential individual units be identifiable as separate entities. Bedr should afford opportunity retreat and privacy: if 2-B, plan so that each patient has clearly defined individual area. Conversely design and furnishing of public areas should encourage sociability, supplementing formal treatment with therapeutically beneficial, informal patient/patient and patient/staff meetings. Place nurse/security stations so that staff engaged in routine activities can observe patients casually. Unobstructive nature of such surveillance important psychologically in alleviating persecution complex. Hierarchical arrangement of staff and patients in group therapy rm inhibits patient involvement. Square or circular seating space affording mm distraction, with circular seating arrangement, probably ideal. Mentally disturbed persons commonly show symptoms disorientation with regard to time and space. Views and contacts with outdoors and living plants aid patient's comprehension of time and season; direct and clearly defined circulation patterns, supported by such aids as graphics and colour coding, inculcate sense of security. Colour plays important role in therapeutic process: eg yellow and orange help dispel lethargy among geriatric patients. Hospital psychiatric units Similar considerations apply psychiatric units within general hospitals. Since patients generally ambulatory, day rm and therapeutic activity rm assume special significance. Although exigencies of hospital planning seldom allow direct access outdoor areas at ground level from psychiatric unit sunny outdoor roof terrace should form integral part, particularly for geriatric patients. 1 Capital District Psychiatric Center Albany New York USA accommodates 400 inpatients in 16 residential units each of which also serves 25 day patients: upper of 2 superimposed units set back from lower creates outdoor ter while lower has direct access to landscaped site; treatment, educational, recreational, admin, research & service dept housed in 4-storey chevronshaped structure, joined to residential units by sky-lighted, brick-paved, indoor mall which has colourful banners, informal seating groups, beauty & barber shop, chapel, music & games rm, laundromat; plan at mall level 1 geriatric unit 2 adult unit 3 pediatric units 4 psychiatric outpatient clinics 5 consult 6 volunteers 7 dining 8 admissions 9 med records 10 emergency clinics 11 business 12 free-standing colour-coded stairs in mall each serve 4 residential units, supplemented by elevators for handicapped Arch Todd Wheeler & Perkins & Will Partnership. 2 Hospital for mentally disturbed patients founded 1844 in Providence RI USA, which has been upgraded and expanded, stands in beautiful grounds by Seekonk river a first level b second level c third level key 1 lob 2 admin 3 admission & testing 4 emergency 5 med records 6 activity therapy 7 day hospital 8 interior courtyard 9 inpatient units 10 food services & cafeteria 11 existing 12 intensive treatment unit 13 interior garden below 14 professional off 15 diagnostic/treatment Arch Hillier Group a b C 2 2
WARD UPGRADING Although wards have always been designed for care of sick those built before 1940 were often intended for bedfast patients. Since then advance in technical nursing has allowed quicker throughput of patients most of whom fully ambulant for 2/3 of stay; thus demand increased for nurse working rm and patient day areas, washing and sanitary services. Older wards, structurally sound but ill equipped for present day standards, therefore suitable for upgrading, particularly those with useful life of at least 15 years. Moreover, taking factors below into account, can be worth considering upgrading bldg scheduled to last only 5 years. Factors Number of patients to be cared for under sub-standard conditions if ward not upgraded, eq 28-bed ward with 80% occupancy and 5-day av stay has throughput of approx 1 600 P/yr and 8100 in 5 years Number of nurses to be trained in sub-standard accn, eq 28-bed ward with 6 students on duty during day and 2 at night for 6-week period equals 70 students/year or 350 in 5 years Proximify to ancillary supporting accn Change of use from acute fo long stay wards Amount of money available 1 Reallocation & division of spaces, no extension to existing ward: existing 29-B, upgraded 25-B 2 small sanitary annexe added: existing 29-B, upgraded 28-B 3 corr& group of nurse working rm & wc added: existing 26-B, upgraded 30-B 4 extension added to long wall of ward: existing 31-B, upgraded 28-B 52 wards joined with core ot nurse working rrn: existing 29-B each, upgraded 52-B total Key to ward plans C or C'd — cpd Con — consult rm D — duty rm Disp — disposal rca Dr — doctors rm DR — dayr DSR — domestic service rm E or Equ — eqpsto fl flower rm I — incinerator k — kitchen L — linen sto Lab — laboratory & test cm NS — nurses station OP — outpatients wr PC — P clothes lockers Prep — preparation rm Rec — receptionist S — sisters cm Sec — secretary SI — sluice St — sto Staff — staff wc T — treatment an t — trolley (cart) tx — telephone V — verandah W — waiting ar for visitors Community 165 Hospitals 900900 Lt I nT1 9 üü u no existing 3 existing 9 5 tom 15 ão ft _JJJL.Li_ifl00009000009900 runjnuoaonuugu5y extension courtysrd upgraded $ Is I existing ..LL.J onEEur, _____ cc II U U U U U U U U U U U 4 ? iptm i existing EILLsJ Equ stsff spgrsded ielevsto •I• JilhhiLk aH U.1U Ut UIU .UTII .UIU rninw nuu existing 00 fl dsr .c.,ci.ict.. go]. U. staff 9 9 lp 1 3ff upgrsded OR 5
166 Community Hospitals 2 Ambulance critical dimensions, standard London England ambulance: turning circle 14.17 m, turning clearance circle 15.25 m 4 Automatic doors toP entrances layouts: A for set of 900 swing doors with safety barrier between each direction of traffic flow; B for set of sliding doors with parking space for doors in open position: max recommended size for each leaf 900 C 3 cleaning zones for dirt control: external zone should have open grid type matting suitable for wheelchair user, intermediate, matting with built-in scraper action, inner, non-slip dust control matting 5 Exam & treatment rm 10.4 m2, for ambulant or wheelchair P 1 sliding door 2wastesack 3toweldispenser 4sk 5trolley 6dispenserwithdrawer 7 sheMng 8 writing surface 9 swivel stool lox-ray viewer 11 wheeledcouch l2chair l3exam lamp l4twin 13-amppoint 15 emergency call button 16 light switch 17 x-ray film rack 18 coat hooks ENTRANCES FOR NON-AMBULANT CASUALTIES & OUTPATIENTS All patient entrances must be suitable for those disabled or in wheelchair —*p86 and must provide dirt control zone. Doors to A & E —÷pl 68 must allow accident trolleys —*pl 66(11) easy entry. In A & E and to lesser extent OPD standard practice to provide automatic opening doors —*(4). Although these can be expensive and unreliable usefulness outweighs disadvantages in areas where wheeled access required. Two main types: both actuated by pressure mats or electronic devices. Some manufacturers supply outward opening swing operated mechanism to override normal operation in emergency. Design area between 2 sets of doors to take trolley pushed by staff member, without obstruction from door swings etc (2700 clear), Integrate 3 dirt control zones into design. Provide canopy or recess doorway to shelter doors. If ambulance required to back up to door allow 3200 to underside of canopy—(2). OUTPATIENTS Outpatients dept (OPD) provide consultation, investigation, diagnosis and treatment for patients who require little or no recovery services afterwards and are not admitted to acute wards. Most patients referred attend session at specific clinic by appointment: receive initial diagnosis and treatment, eg injections. Sessions approx 3 hr long (10 per week) and held 0900—1 200 & 1 400—1 700. Each doctor may use either 2 combined consult/exam rm or 1 consult with adjacent exam rm —n(5)(7) p168(3) during 1 session. Am use approx 9 sessions/week: formula for number of rm required: rm sessions/week = number of rm required 9 After consultation patients may be sent directly or by appointment for further diagnosis and/or treatment to units within OPD, eg plaster rm, physiotherapy, operating theatre or endoscopy rm. Endoscopy rm — p167(2) requires accn available for patients under sedation and perhaps ante-rm for pre-medication and holding (NB fibre-optic cold light sources must not be used in conjunction with inflammable anaesthetic gases). Units may serve whole hospital; theatres and ancillary rm may be part of main hospital theatre suite. Clinics which can use standard accn: general med, general surgery, dermatology, gynaecology, paediatrics, ante-natal, fracture, orthopaedic, psychiatry. Clinics which require special accn: opthalmology, ear, nose & throat, dental. Clinics should have own reception point and waiting area 36 m2 (based on 1.4 m2/P). 6 OPD Falkirk Scotland Royal Infirmary 1 wr 2 porter 3 trolleys 4 prams 5 hearing aid 6 wc 7 consult 8 do 9 staff 10 sto 11 audio 12 treatment 13 preparation 14 disposal 15 CSSD sto 16 eqpsto 17 optician 18 eye 19 workr 20 dental 21 off 22 dark mi 23 orthoptist 24 ECG 25 studio 26 technician Arch Wilson & Wilson & Scottish Development Dept 7 Combined consult/exam rm, 15.48m2 1 chair 2couch 3 scales 4 steps 5 hooks 6 couch-cover dispenser 7 disposal 8 exam lamp 9 wpb 10 desk 11 hb 12 work top, sto under 13 eqp trolley (cart) 14 curtain 15 sphygomanorneter bracket 16 writing shelf w fl® 14 2 0 Standard dhnics special clinics generai med ante-natal opiliahiokigy reception general surgery fracture ant main waiting dermatology Orthopaedrc dental reonrds gynaecology psychiatric diagnosis &V'treatment V' operating plaster rm theatre suite physiotherapy aadsimetry aççrbance sri radioragnosbc for prosthetics I endoscopy mi reception ar of I I chiropody laboratories ! mali operating theatres nesmhospdalL Ward at I Relationship of clinics to other hospital functions beacon+aerial _______ clearince for clearance br reversing under driving ander EiJ1 fI I :3600 uofoading a ,6oOO 3 Car parking space for a wheelchair P b ambulant disabled P sheltered parking desirable barriers down total length hospital street insate hospital street ElIllIlIllIflhllIll 1 — actuator . lIllllllFFtFJ ssnJMMMM10 :1I sFediafo % oubade I qi; I U canopy j j canopy canopy AL eL._._\_ cL__N_ 13 .1 7 flU R17 wall a 13 15 16 Ii wait ri b
Community 167 Hospitals: out patients 0 5 10 15 20 25 I I I rn —'I. 16 35 45 6 809 1 21 1 L7NEPLI 11 IT f 21 I_,ti. — 4[Th1h11Tfl1 14 bEEI 9 1 Ante-natal clinic Aberdeen Scotland Maternity Hospital 1 prams 2 children 3 P wc 4 sister 5 exam 6 lecture rm & mothercraft 7 tutor 8 study rm 9 consult 10 staff wc female 11 lecture rm 12 do 13 elevators 14 work ar 15 staff wc male 16 typists 17 health visitor 18 nurse 19 reception 20 urine testing 21 waiting ar Arch George Trew Dunn & Partners 2 Endoscopy rm —.pl 66, 17.28 m2 1 sk 2 work top 3 wall cpd for fibre optics 4 trolley (cart) 5 anaesthetic trolley 6 stool 7 intravenous drip stand 8 linen holder 9 kick-about bucket 10 adjustable lamp 11 writing surface with drawers 12 surgeons basin 13 warning light 14 shelf with light 1510w pressure suction 16 high pressure suction 17 triple x-ray viewer 18 pin board 19 telephone 20 coat hook 21 shelves for preset trays 22 towel dispenser 23 cpd 24 drawers 25 shelving 26 alimentary trolley 27 bin 28 P trolley 29 DDA cpd hooks br machine tools cleaning machines §IrH 213 -.i"L 1400 2150 5 Clinette & urine test rm, 2.7 m2 + 6.45 m2 1 urine specimens collector 2 reagent store 3 work top, sto under 4 slop hopper & drainer 5 disposal 6 basin 7 hatch 8 shelf 9 hand rinse key 1 basin with shelf 2 paper towels 3 waste 4wc 5toiletpaper 6 mirror 7 hook(s) 8 sk 9 gulley 10 P trolley (cart) 11 hose point 12 disposal 13 sack holders 14 trolley 15 stapler (3)(5)—(8) room layouts suitable other depts & wards 10 Plaster application rm, 33.5 m2, serves OPD & A & E not suitable for general anaesthesia because more than 1 P space key 1 oven on trolley 2 double x-ray viewer 3 sto shelves 4 plinth 5 chair 6 plaster-saw mounting 7 clothes hook & mirror 8 trolley 9 curtain lOsk & drainer with plaster trap 11 steps 12 ceiling hook 13 plaster cast disposal 14 waste 15 sk & drainer 16 plaster dust extractor 17 wall hook(s) 1600 6 Wheelchair lay, 2.56 m2 —'162 7 Cleansing rm, 13.4 m2 14 LL. 1700 wall B 1516 A wall C J4-U-1 11 6 12 wall A __j25fl 24 ro m 4 4 iS ttis 13 I 171 II I I I I I I I 9I I I I I I • I T1 9 1 i 12 1'Sft 9 Plaster removal rm, 22.3 m2 serves OPD & A & E 0 1 2 3 4 5 I Im iS i5n ___ [1 ±LJ1 2lbottles dryerI(( )LJLJU ' shelues buckets - trolleys under sk [ under looker ED 1 3000 T 3 Domestic service rrn, 7.5 m2 4 Suction unit 11 Tilting accident trolley
168 Community Hos pita/s ACCIDENT & EMERGENCY Accident & emergency dept (A&E) provide 24-hr 365-day/year service for accidents and med emergencies occurring in home, at work, at sports or travelling. Patients normally taken to DGH (community hospital) with A&E resources. Dept provides resuscitation, reception and first stage exam; patients can then be discharged, sent to another part of hospital for further investigation and treatment, admitted as inpatients, or sent by ambulance to hospital containing regional specialty, eg burns unit, neurosurgery —p173--5. Patients dead on arrival taken to small rm near entrance before being removed to hospital mortuary. For dept close to potential sources of accidents (airports, motorways) extra provision for resuscitation needed. A&E need to be on good access roads with drive-in entrances for ambulances, sheltered from wind and rain by covered ways and battle walls. Entrances should have 2 sets of automatic fail-safe doors to prevent draughts, with enough space to manoeuver stretchers and trolleys —4p1 66(4). Dept must have direct access for patients on trolleys to all parts of hospital, particularly radiology .—pl69 170, plaster rm —*pl67(9)(lO), surgical (OPD) —pl7l 172 and short stay wards. Resuscitation rm must be fully equipped with med gases and be close to entrances. Doctors, often on duty for long periods, require comfortable duty rm. Relatives of patients need access to public telephone. Interview rm required by doctors for interviewing relatives and by police for interviewing witnesses. Generous sto required for stretchers, blankets and trolleys. For benefit of patients, relatives and escorts, who may be in severe state of shock, all waiting spaces as well as clinical areas should be heated to mm 21°C. CASUALTY DEPARTMENT Casualty dept provide 24-hr 365-day/year service for casual attenders and patients referred by GP for immediate examination and treatment; generally linked to A&E; can share some nurse working rm and staff services. But combined only for convenience: specific functions very different. Patients arrive on foot or by car, usually accompanied by relative or escort. Casualty dept should have separate entrance, preferably with double set of automatic fail-safe doors —pl 66(4). Patients come without appointment and may have to wait some time before being examined and treated; provide generous waiting space, with beverage point and at least 4 wc, 2 suitable for wheelchair users p167(6). 1 A & E Eastboume England OGH 1 ambulance entrance 2 casualty entrance 3 trolleys, wheelchairs 4 porter 5 flying squad 6 trolleys 7 staft do 8 rest rm 9 1-B 10 nurses station 11 clean supply 12 duty doctor l3cleaner l4reception l5doctorsstation 26chargenurse l7wc 18 assisted b 196-B 20 interview 21 dirty utility 22 resuscitation ar 23 disposal rm 24k 25 surgeons changing 26 sto 27 dayr 28 p changing male 29 P changing female 30 doctor 31 nurse admin 32 housekeeper 33 anaesthetic mi 34 minor operating 35 crutch sto 36 plaster mi 37 ear, nose & throat (ENT), eyes, noisy children 38 septic treatment 39 trealment ar 40 fracture & orthopaedic clinic 41 waiting 42 clinic reception 43 P lay 44 appliance fitting 45 canopy over Arch SETRHA Full snack bar can be provided if shared by OPD —*pl 66. Patients who return for further dressings or treatment given appointments outside morning and evening rush hour for casualties so can use same accn. Exam and treatment rm preferable to cubicles for patients requiring audio and visual privacy (can undress and be seen in comfort); casualty doctor will work set of rm. Cubicles suitable for small cuts and abrasions which do not require patient to undress. Separate provision may be requested for cleansing patients and dealing with infected wounds. Peak periods for both A&E and Casualty dept invariably coincide with weekends and public holidays: essential that sufficient stores and nursing eqp be available either by providing extra sf0 at point-of-use or by giving staff access to central sto during holidays and off-peak periods. 2 A & E Falkirk Scotland Royal Infirmary 1 ambulance 2 ambulant P 3 prams 4eqp 5 trolleys 6 treatment 7 interview 8 sister 9 duty 10 wc 11 to theatres 12 disposal 13 preparation 14 to shared x-ray 15 visitors 16 exam 17 resuscitation 18 reception 19 plaster 20 sto 21 do Arch Wilson & Wilson 3 Exam & treatment rm or bay, 10.15 m2, designed to allow for trolley exchange system; P on emergency trolley can take place of trolley in rm 1 sliding door 2 waste sack 3 towel dispenser 4 sk 5 trolley (cart) 6 dispenser with drawer 7 shelving 8 writing surface 9 swivel stool 10 x-ray viewer 11 emergency trolley 12 chair 13 trolley 14 exam lamp 15 twin 13-amp point 16 emergency call switch 17 light switch 18 x-ray film rack 19 coat hooks 4 Resuscitation rm, 24.36 m2 1 work top 2 suction unit 3 stool 4 trolley (cart) 5 surgeons sk 6 linen sack 7 waste sack 8 work top with sk 9 writing surface, shelves over 10 mobile x-ray 11 anaesthetic trolley 12 drip stand 13 oxygen suction gas 11 _....J I 112.L13 I ij 14 ——J r2o f J2OJ1] 15 15 _______ C) 5 10 15 2Dm 1 ,2 16 32 48 646 9 5 10 5 20m 16 32 4 645 1 15 16 17 S B 12 ________________ 13A LJi aI) B L.J T 15 I Lis wall A j
Community 169 Hospitals 1 Diagram of relationships between radiology & other dept in representative USA hospital 2 Easthoume England DGH x-ray dept 1 lavage & disposal 2 wc 3 sto 4 clean supply 5 recovery 6 x-ray rrn special 7 x-ray mi barium 8 bed holding 9 waiting lox-ray mi general purpose 11 dark rm 12 sorting & viewing 13 x-ray mi A & E 14 cleaner 15 reporting rm 16 film sto 17 disposal 18 superintendent radiographer 19 staff rm 3 Diagnostic x-ray mi designed by American Health Facilities/Medical Planning Associates Malibu USA 1 dispenser unit 2 step-on waste receptacle 3 surgical/instrument dressing cabinet 4 apron & glove rack 5 to daylight processing ar 6 intercom 7 lead glass vision panel 8 partition 2100 h 9 x-ray control unit 10 ceiling tube mount 11 generator 12 tube carriage 13 3-size film dispenser 14 radiographic table with tomographic attachment 15 fluorescent light fixtures wall mounted 16 footstool with handrail 17 side chair 18 warning light 19 to lay 20 mirror 21 corr RADIOLOGY DEPARTMENTS —p1 70 X-ray or radiology has 3 major sub-divisions: diagnostic, which may include ultra-sonics, fluoroscopy etc; radiation; nuclear medicine. Depending on admin pattern or on physical/functional relationships with other dept these may be arranged contiguously or separately. Diagnostic radiology Provides internal images of patient either on film (radiography) or on cathode ray tube (CR1— fluoroscopy). Must be provided for outpatients and inpatients both for routine examinations and for emergencies. Dept therefore has relationship to OPD, medical, intensive care and surgical units. Separation of inpatient, typically on trolley, stretcher or wheelchair, from outpatient in street clothes and often bloody, should be maintained long as possible, certainly through entrance, reception and waiting: if dept large enough also through radiographic procedure and exit. Arrange x-ray procedure rm so that patient's travel path does not cross that of radiology technician until they meet in procedure rm. Easy trolley/stretcher access to x-ray table essential. Plan dept so that technician travel time kept mm particularly between rm and film processing. Simple x-rays to locate fractures or position of catheter take less than 10 minutes; more complex or intermittent procedures involving barium swallows or radio-opaque injections may take up to 3 hr to complete while patient waits in or near dept. Design for following requirements: separate rm for ultrasonography and for thermography; bench with drinking water, bottle-trapped sink with sto cpd over exclusively for barium preparations and wc for patients who have had barium enemas both next to 2 x-ray rm; rm and viewing bay to process and check accuracy of films (normally completed within 15 minutes of being taken): automatic plumbed-in processors need special drainage; forward waiting area on basis of 1.3 m2/P plus 1.02 for relative or escort; extra screened space for 2 patients' trolleys; 2 wc suitable for patient in wheelchairs —+pl 67(6). Each x-ray rm must be screened from other parts of bldg either by barium plaster or by lead sheeting, both very dense heavy materials. All glazing should be in lead glass. X-ray eqp heavy and requires ceiling heights between 3100 and 4000, extra moveable structural beams suspended from ceiling will be required. Design floors and ceilings to take extra heavy loads. Entrance doors to x-ray rm should be 1 400 wide in 2 leaves 900 + 500. In addition to above mentioned areas support spaces for film sorting, film reading by radiologists and filing necessary, also spaces for transcribing reports, sto for eqp and supplies, admin off and often conference rm. X-ray beam carries inherent danger to living cells: proper shielding of all procedure rm essentIal; must be designed and supervised by raditlon specialist. In UK comply wIth Code of Practice for Protection of Persons exposed to lonising Radiation. Eg 1312 11 I 1312 11 13 1100 p 1700 7200 1 [ [a [II 4 Radiodiagnostic mi/changing cubicles, 28.8 m2 1 transformer 2eqp trolley 3 chest x-ray 4 steps 5 bucky table 6 safety screen 7 control unit 8 cassette hatch 9 clock 10 sto unit 11 bench seat 12 shelf & mirror 13 hooks 5000 3500 *15004 I 5 I closed open 5 Viewing & processing rm, open & closed layouts 1 tanks & water nstallation 2 cassette hatch (from radiodiagnostic rm) 3 dark rm 4 processor 5 sorting & viewing
170 Community Hos pita/s 2 Bucky table: rm h required with floor/ceiling tube stand mm 3000 max 4000 RADIOLOGY DEPARTMENTS (cont) Radiation therapy Technique whereby radiation used reduce or eliminate carcinogenic cells: generated either by natural source such as radioactive cobalt or by man-made as in linear accelerator. Because of massive quantities of radiation used extremely heavy shielding required contain it: so heavy that some reg require this dept be placed at ground level. Whole unit constructed of dense concrete: walls, ceiling, floor pit thickest (approx 1 200) within 3600 arc of eqp, remainder approx 600. Design all steelwork, conduit, piping to prevent radiation leakage. Viewing porthole double-skinned with highly corrosive fluid infill (zinc bromide solution); door locks controlled from console in adjoining rm. Procedure rm with their shielding mazes must be large enough accommodate eqp plus access for patient on stretcher/trolley. Spaces required for patient reception and waiting, examination, treatment planning, mould making for shielding needed for patient during treatment, off and work space for staff. Off and lab space also needed for physicist for calibration and radiation safety of eqp. Patients taken into rm containing eqp and so positioned that all 3 sources of radiation converge on diseased part of body; attendant then retires to control rm from which patient can be observed through heavy lead glass porthole or by tv. Procedure can be very frightening for patient: ventilation, temp and general environment control of utmost importance. Pastoral photomural or fresco on walls and ceiling within view of patient during treatment, together with false window with pastoral view' opposite entrance, will help alleviate fears. Nuclear medicine Diagnostic procedure involving ingestion by or injection into patient of radioactive materials which then traced by scanning eqp. Am used for scanning require some shielding; must be large enough accommodate eqp, patient on stretcher/trolley, console and technician. In contrast to diagnostic or therapy procedure rm level of radiation low enough allow 2 or more patients scanned simultaneously in same space. Support spaces include reception and waiting, off, sto, well shielded 'hot lab' beside procedure rm for sto and preparation of radioactive materials. CAT scanning Relatively new method of non-invasive imaging of internal organs; although diagnostic procedure, often in separate suite with own procedure rm, control rm, computer eqp space and support areas. NB new diagnostic procedures continually developed; design should allow addition of mi/services when needed. 5 X-ray film cabinet; will hold approx 10000 envelopes (360 kg), 26000 x-ray films (1040 kg): total floor loading 1 728 kg/rn2 6 Standard x-ray film very heavy (155 kg/rn run): max unsupported w of shelf 900; each radiodiagnostic rm produces approx 625 envelopes/ month 400 concrete 600 concrete 1JJE[ L1— light1 duct under I dttlaii p6 Inc cobait und 290001 800x500 3 Cobatt unit for radiotherapy Pembury England Arch SE Thames RHR 4 Typical cyclotron 7 Transformer: weight 380 kg 8 Radiodiagnostic control unit QJ -t
Community 171 Hospitals 2 St Joseph Hospital Tacoma USA has elliptic oper rm arranged round central control rm Arch Bertrand Goldberg Associates 3 Stobliill oper theatre suite: 8 standard theatres with clean & dirty corr 1 consult anaesthetist off 2 anaesthetist secretary's off 3 duty anaesthetist 4 student lecture rm 5 wc 6 male changing 7 female changing 8 porter 9 cleaner 10 workshop 11 theatre superintendent 12 reception ar l3dirty utility l4transfer l5cleanutility l6recoveryar l7darkrm 18 nurses rest rm 19 surgeons rest rm 20 technicians rest rm 21 teak 22eqp sto 23 theatre sister 24 lab 25 endoscopy 26 calorifiers 27 refrigeration plant 28 preparation rm 29 oper theatre 30 exit lob 31 anaesthetic rm 32 scrub-up ar 33 monitor rm 34 plaster mi 35 plaster sto 36 disposal bay 37 disposal lob 38 el gear 39 med gases 40 stair to air-conditioning plant 41 TSSU 42 staff rest rm Arch Cullen Lochhead & Brown OPERATING THEATRES Surgical and delivery suites increasingly considered centres to which patients brought for procedures too complex for handling in physician's off or treatment area. Unlike traditional suite with different rm for different services (eg, ENT, orthopedic) suites now collection of multi-purpose rm. In large institutions more than 1 suite likely be provided, based on usage: short (1—3 hr) procedures, such as ambulatory, frequently separated from general, av length (2—4 hr) and very long (6—8 hr) procedures. Delivery suites, formerly completely separated from surgical, today commonly alongside or integrated. Design elements Consider patient flow: entrance, control, holding pre-anaesthesia, operating, recovery. Consider staff: control, clean-up. Consider eqp, particularly instruments and other goods which must be sterilised between each use: done locally (within suite) or centrally (for hospital)? Let volumes guide. Consider sharing: like types of procedure rm can share supplies, cleaning etc. Consider testing functions: 'quick' lab tests, x-ray etc: how will they be done? Space needs Space suites need per inpatient bed varies greatly, depending on whether ambulatory surgery offered, whether hospital has teaching programme and other such factors: generally 28—46 m2 for each operating theatre. Space for circulation, nursing and medical staff and non-functional bldg elements such as air-conditioning eqp usually high ratio in this setting, perhaps 80% above individual rm needs. If reprocessing goods done within suite 28—37 m2/operating theatre or delivery rm must be added. Locker rm, showers and rest rm for staff should be provided based on number staff expected. Circulation Crucial to design of high technology operating and delivery suites; 2 basic types: single corridor and double corridor or 'racetrack'. Single has 1 corridor leading to all operating/delivery rm, used for patients, staff and eqp: sterility maintained in each user of corridor and within theatre itself; each rm preceded by scrub-up ar and has provision for sterilisation within it or between 2 rm. 'Racetrack' arranges rm in 'circular' fashion with outside corridor or rm for staff and eqp, presumed sterile; locker rm 'bridge' corridors; staff and eqp leave with patient; staff 'bridged' back through locker rm and showers. Corridor for P trolleys 2: 45mw; others 1.5mw. Cleanliness Also critical in operating/delivery suite. All materials, surfaces, joints etc must be easily cleanable and durable for repeated washings: sealed joints to prevent infection. Anti-static materials should be used where patients likely be connected anaesthetic machines. Check requirements with technical literature. 4 Vedesta system modular oper theatre uses basic standard octagonal to form series of units for use in new hospitals or for upgrading; 10 sizes available, ar from 23.22 m2 —436 m2 1 domestic staff change 2 disposal 3 sluice 4 inspection/sto 5 generators/batteries 6 air-conditioning 7 emergency corr 8 theatre 9 sterile mi 10 P in 11 P out 12 surgeons nurses orderlies in 13 surgeons nurses orderlies out 14 sterile supply 15 soiled instruments/disposal 16 cleaned instruments 17 access to services 18 sterile supply 19 anaesthetic rm 20 exit 21 gowning 22 scrub-up 23 med gas 24 instrument sto 25 nurse staff rm 26 surgeon staff rm 27 orderlies staff rm 28 recovery 29 mobile eqp 30 transfer 31 sister 32 change — NB servicing of lighting eqp completed outside theatre 1 Typical floor of surgical & special services bldg Massachusetts General Hospital USA Arch Perry Dean Stahl & Rogers p 123m JH 0 5 lOft ? 1P 3p 6 6 18ft 171615141312 1110 I I 1;
172 Community Hos pita/s OPERATING THEATRES (cont) 1 Oper theatre suites Ninewells Hospital Dundee Scotland, designed for teaching I service corr 2 oper theatre 3 x-ray 4 TSSIJ 5 access cor 6 female surgeons 7 male surgeons 9 nurses 10 students 11 anaesthetic dept l2surgeonsrest l3sto l4nursesrest l5nurseworkrm l6lecture rm 17 junior staff 18 recovery ward 19 reception ward 20 senior staff Arch Robert Matthew Johnson Marshall 3 Anaesthetic rrn, exit mi, scrub-up rm, sterile sto: el outlet points in anaesthetic & exit to be sparkless & hoseproof, in sterile sto & exit hoseproof only 1 sterile mi 2 oper theatre 3 table 4 B 5 hb 6 sterile sto 7 scrub-up rm 8 anaesthetic mi 9 anaesthetic trolley 10 anaesthetic machine llservicepoints l2exitrm l3gowning 5 Nut! ield Orthopaedic Centre Oxford England: 1 conventional theatre, 2 clean-air glass enclosures' with filtered air & special suits with air intake & exhaust for staff 1 ramp 2 1-B intensive care ar 3 barrier nursing 4 cleaner 5 ste 6 clean utility 7 dirty utility 8 nurses station 9 fire exit 106-B intensive care 11 office 12 seminar/rest rm 13 staff 14 locker rm 15 visitors 16 from wards 17 waiting 18 B park 19 changing rm a surgeons b orderties c nurses 20 rest rm a nurses b orderlies c surgeons 21 theatre sister 22 plaster rm 23 transfer zone 24 orderlies bay 25 linen 26 monitor eqp station 27 oper dept 28 exit bay 29 anaesthetic rm 30 oper theatre 31 gown/scrub-up 32 forward holding 33 switch rm 34 sterilisers 35 battery rm 36 service ar 37 med gas 38 plant rm 39 loading dock 40 issu 41 preparation 42 scrub-up 43 oper rm 44 disposal bay 45 dark rm 46 mobile x-ray 6 Typical oper table in standard position: will tilt in both directions; also designed take various attachments; small wheels used put very high rolling loads on floor weight approx 230 kg, mm h approx 700, max h approx 1 040 4: 11 ________ 13j16 biii r&nl 0 5 10 iBm 16 32 488 1 isolated power 6700 panel 2gas&el service panel 3 anaesthetists table 4 monitor 5 anaesthetists stool 6 anaesthesia gas machine 7 x-ray film illuminators explosion proof 8 kick bucket g surgeons stool 10 deep canily surgical illuminator 11 eleciro-surgical and l2doubtebasin 13 mayo stand 14 single panel lsmobdetvcamera& recorder 16 ceiling gas & el service 17 instrumentable 18 case cart/trolley 18 aub-stedlisation 20 con 21 scrub-up ar Oesign Axnencan Health Facililies/ Medical Planning Associates 11 118 2 General oper rm ? I t Sm 1 1ft 7 Suspended operating lamp weight 8kg 8 Adjustable ceiling mounted exam lamp, weight 4.5 kg 4 Opertheatre, 36.10 m2; all el outlet points in anaesthetic rm & theatre to be sparkless & hoseproof 1 control panel 2 dressing trolley/cart 3 instrument trolley 4 basin stand 5 table 6 kick basin 7 stool 8 swab stand 9 anaesthetic machine 10 anaesthetic trolley 9 Anaesthetic machine 10 Mobile suction unit: this type also available without castors or pull handle; units for connexion to piped systems do not have lower part of control box
Community 173 Hospitals: special units INTENSIVE CARE Hospitals contain 2 basic types bed accn: 'hotel' for patients not needing continuous direct visual supervision or life-sustaining eqp; 'critical' (UK intensive) for patients whose survival depends on constant attention and/or complex life-support eqp. Proportion of critical to hotel and of number of types of special care units increasing. Special units include cardiac, spinal injury, burn, transplant, respiratory, neurosurgical, limb fitting, physical medicine. Usually form part of larger hospitals (regional specialties in UK); very large hospitals may have all of them. Design considerations Will patient be conscious, require privacy, toilet, constant nursing attention? Will location or configuration of unit help or hinder patient's recovery? Can staff see all patients easily? Is ratio patients/staff station appropriate? Can staff get help quickly? Can they reach services (medications, uty etc) and support (lab tests etc) quickly and easily? Can they examine patient easily? What about infection control? Can special eqp be brought quickly bedside in emergency? Can monitors, pumps, screens be Because of length of each operation and its exacting nature neurosurgery units rely heavily on support services. Ratio of population to beds 1:100000. 2 theatres shown —(3) serve 60 beds. Theatres egg-shaped to promote smooth flow fully conditioned air (21 changes/hr). Heatfiltered theatre lamps set in ceiling and 1 wall. Monitoring eqp and viewing gallery in mezzanine with viewing ports in domed ceiling. Each theatre equipped with 5-panel x-ray viewing box, oxygen, nitrous oxide, suction, nitrogen for pneumatic tools, electro-encephalograph (EEC) connexions, and CC1V for transmission of encephalograph recordings. Anti-static flooring and flashproof el outlets required. X-ray rm attached to theatres heavily equipped for cranial and spinal radiography. Separate lab for electro-encephalography and special eye exam. Support measures include physiotherapy with hydrotherapy pool. Wards attached to neurological theatres: mixed sex 20 beds (4 x 4-B, 4 x 1-B). Early ambulation of patients in need of observation reflected in size of day and sun rm; patients encouraged to have visitors who can help return normal life by using these and adjacent flower bay. SPINAL INJURY Care for young people, who suffer from paralysis as result of accidents, eg motor cycle. Require 100% care: nearly always doubly incontinent; because of shock to system can be aggressive towards staff and visitors. Occupational therapy, physiotherapy and study form vital part of rehabilitation. Patients may take months recover; care can be divided into 3 stages: patients bedfast: can only be moved for bathing and treatment in horizontal position; patients spend part of waking hours in wheelchair: therefore more mobile (after this stage some patients go home and return for stage 3); patients begin move round on crutches or with walking aids. Stages 1 and 2 require 20—24 beds, stage 3 28—32 beds. Provide approx 20% beds in 1-B wards and remainder in 4- or 6-B. Beds wider than normal (1 000); allow mm bed centres of 3500. Provision of nurse working rm similar to that for physical/mental handicapped units, —*pl 62—163. easily read by staff? Can eqp be stored handily when not in use? Bed unit basic space module: number beds related to unit, decided by usage or projected usage: 6—7 usual max. Unit must be sized for bed (larger and larger as new features added or structured), eqp (respirators, pumps, monitors), people (many as needed during resuscitation): common today 11—15 m2/unit. Access from entrance to bed unit and between critical. Spaces required include: nurse/physician for supervising monitors, charting, consult; support for medication station, uty; special use, egtreatment, procedure, x-ray, based on patient plus staff/eqp 11—15 m2; amenities such as rest rm, locker, wc. Keep distance from control station or viewpoint to patient small so that eqp can be read and patient actually seen. Bed unit may be enclosed in rm (eg coronary care, where patient conscious, or where infection control or separation patient from noise necessary) or open (eg for max visibility and quick access where patient unconscious). Staff changing arrangements similar those for operating theatres; visitors if allowed, may be required change shoes, wear gowns and masks. 3 Neurosurgical oper theatres Western General Hospital Edinburgh Scotland I elevator 7 med staff 12k 17 domestic service 19 eqp sto 21 sterilising annexe 25 staff toilets 26 wr 29 secretaries 30 staff conference mi 31 plaster rm 32 eye rm 33 dept/theatre sister 34 EEG 35 x-ray rm 36 dark/work rm 37 theatre ha 38 scrub-up ar 39 changing rm 40 anaesthetic rni 41 oper theatres 42 preparation rrn 43 scientific observation 44 stair to viewing gallery 45 stair to theatre EEG 55 engineering plant 910203Gm 3264966 N 1 P unit intensive care pavilion Long Island Jewish-Hillside Medical Care 2 Master plan Temple University Hospital Philadelphia USA showing Center USA relationship between specialty units Arch Perkins & Will NEUROSURGERY 0 5 10 IS 20 25 I I I I Im 16 32 48 64 80 $1
174 Community Hospitals: special units 1 Relationship between cardiac surgery unit, intensive care, coronary care, nursing rm at St Vincent Medical Center Los Angeles USA Arch Daniel Mann Johnson & Mendenhall 3 i — 17 12 1i 1'6 ip 32 1,5 4 64(1 CARDIAC SURGICAL 2 stages of care: intensive therapy and intermediate care. Patients vulnerable infection: 2 out of 6018 beds should be in isolated bays with full height walls. Patients most vulnerable at immediate post-operative stage when in transit and not attached to electrically operated ventilators or monitors. Intensive care units must therefore be close to operating theatres. Example illustrated —*(2) also shows area to be upgraded as coronary care unit. Requires bio-chemistry lab; some research and staff areas can be shared. Provide for relatives overnight stay close to but not in TRANSPLANT For replacing damaged or diseased organs (usually kidneys) by direct transplant from donor: need paired operating theatres, one for donor, one recipient. Patients nursed in 1-B wards in carefully controlled environment (liable both to infection and to infect others). When donors not available kidneys may be obtained from cold store bank (may hold other surgical spares required for transplant surgery such as skin, eyes, bone marrow, bone and blood). LIMB FITTING CENTRE Considered advisable hold clinics in DGH (community hospital) save patients, often elderly and diabetic, from having travel long distances. All patients require rehabilitation for everyday living; walking training should be provided for, either in centre or within wheelchair distance. If centre provides early post-operative walking training hostel type beds may be required in or close to it. Patients come to centre for consult, assessment, stump casting and limb fitting, and retum for stump dressings, limb adjustments and walking training. Provide workshops for making limbs: if modular limbs mainly assembly process. Cosmetic covers made on vacuum-forming machines from highly inflammable material; special sto required for this and for paint. For workshops and sf0 areas refer to factory legislation. L ii H k iol 2 F 4 —----- I0 Jc unit. 2 Cardiac surgical unit Stobhill England General Hospital; conversion of existing ward to surgical unit 1 oft for registrars/research fellow 2k 3 sister 4 wclsho 5 womens ward 6 domestic service rm 7eqp sto 8 isolation B 9 corr 2000w 10 intensive care B 11 preparation rm 12 nurses station 13 disposal 14 sluice 15 mens ward 16 wc/sho 17 treatment bathr 18 day rm 19 dining ar Arch E Phillips 5 10 15 I I 11m 16 32 48 (1 mirci lJ E] 6 ((°O 05 a 5k0 0007 0 5 10 15m b 16 2 4ft 9 5 10 1 2 8ft 3 Nutfield transplantation surgery unit Western General Hospital Edinburgh Scotland; mech ventilation to aseptic ar, 1-B wards, clean corr, auxiliary rrn, twin oper theatres, (designed for close control of air movement pattern & pressunsation to mm infiltration) 1 changing 2k 3 sterile supply 4 anaesthetic 5 recipient theatre 6 scrub-up 7 donor theatre 8 decontamination 9 P mi 10 lab 11 P bathr 12 disposal 13 eqpsto 14 elevator 15 entrance ha/waiting ar 16 conference rm 17 secretary 18 director Arch Peter Womersley 4 Limb fitting centre 1 consult rrn 2prosthetist 3 prosthetist off 4 plaster rm 5 fItting rm 6 rectifying 7 toilets 8 treatment 9 domestic service rm 10 staff/seminar rm 11 med social worker 12 walkway 13 entry P/staff/ ambulance 14 entry plant/large materials 15 entry goods/materials 16 wait 17 workshop 18 sto service Arch E Phillips 24 Ft 5 Limb fitting centre consult rm layouts a for 4 suites b for 2 suites c consult rm d walk, fitting rrn, plaster rm 1 walkway 2 plaster rm 3 fitting rm 4 consult rm 5 wc 6 wr 7 entrance 8 admin 9 courtyard 10 from OPD 11 window wall 12 long mirror 13 walking rails 14 plaster chair 15 P wheelchair 16 sk 17 hb 18 desk 19 chair 20 couch Arch E Phillips
Community 175 Hospitals: special units BURN UNITS Seriously burnt patients arrive by ambulance; nursed on special beds in carefully controlled environment. Patients liable to infections which prevent acceptance of skin grafts. Each has 1-bed ward with scrub-up and gowning lobby for staff and wc and hb for patient. Visitors not allowed enter ward: view patient through fixed observation window. Unit has own theatre suite for treatment and skin grafting. 1 Bums unit Queen Victoria Hospital E Grinstead England 1 wr 2 1-B with wc 3 nurses station 4 clean utility 5k 6 sto 7 weighing rm 8 clinical lab 9 doctor off 1 0 visitors wc 11 sisters off 13 visitors ha & corr 14 relatives rrn & wc 15 ambulance bay 16 resuscitation 17 assessment 18 admission rm 19 staff do 20 surgeons scrub 21 anaesthetic rm 22 oper theatre 23 sluice 24 treatment rm 25 theatre corr 26 nursing corr 27 rest rm 28 dirty utility 29 med gases 30 air lock 31 disposal corr 32 interview rm 33 entrance to plant rm under 34 courtyard Arch Donald Goldfinch & Partners 2 Dept of physical med Southern General Hospital Govan Scotland 1 plant rm 2 heavy workshop 3 timber sto 4 light workshop 5 eqp sto 6 duty rm 7 utility rm 8 finished articles sto 9 bathr 10 bedr 11 k 12 senior occupational therapist 13 female staff changing 14 male staff changing 15 hydrotherapy pool 16 gym sto 17 apparatus gym 18 P changing 19 active treatment rm 20 apparatus sto 21 preparation bay 22 linen sto 23 paraffin wax rm 24 female students changing 25 female staff changing 26 male students changing 27 students common rm 28 staff rm 29 passive treatment male 30 passive treatment female 31 interview rm 32 reception/ records 33 waiting space 34 trolley (cart)/wheelchair bay 35 consult mi 36 med officer 37 principal's off 38 upper gym 39 tank ml Arch Keppie Henderson & Partners PHYSICAL MEDICINE Provides med, domestic and often industrial rehabilitation to fit patients, either return work or for active domestic life. Provide for inpatients as well as outpatients: mm population for viable unit 150000. Accn related to type of population to be served; activities include physiotherapy, remedial gymnastics, hydrotherapy, occupational therapy, heavy and light workshops, consult and clinical resources, together with provision for speech therapists, disablement resettlement officers and social workers. Because most attenders disabled accn should be on ground floor with car parking close by (3000 wide bays allow disabled manoeuvre wheelchair from car) —p1 66(3). Special provision children up to age 10, usually within children's ward. Some patients attend for half or whole day, others for 1 session/day; may be need for hostel accn for those who have to travel long distance. Gymnasium should be 10 x 20 x 7.6 m h (for ball games) with bay 1 500 deep off one side for stacking apparatus, and changing rm and wc (1.5 m2/P). Physiotherapy also involves individual treatment cubicles, walking and other exercise areas, wax treatment rm (high fire risk) and splint rm, with offices, interview rm and linen sto. Part of treatment area should have suspended below ceiling, at approx 2000 above floor, reinforced metal grid for connecting slings and pulleys necessary to support patient's paralysed limb during treatment or training. Hydrotherapy pool —*(3) requires changing accn with clothes lockers and sho, including 1 for wheelchair users, recovery areas with couch (1 700 x 2200 deep), utility area for drying costumes and gowns, and possibly washing machine and drier. Provide apparatus bay for floats, cradles etc. Occupational therapy workshops must comply factory regs. 4 Physiotherapy & rehabilitation, 51.6 m2 1 coathooks 3 wall bars 4 hb 5 wheelchair 6papertoweldispenser 7benchseat 11 disposal bin 13 fixed bicycle 15 parallel bars 16 exercise steps 17 mobile mirror 18 mat 19 clock 20 adjustable shelving 21 wall hooks 22 stool 23 trolley (cart)/mat sto box 0 10 20 30 40 50m I I I I I I I I I 32 64 66 126 160ff t850 ±800 t550 drain oo sho trolley! lockers wheelchair changing sho r lockers Q D staff c baseJ electric hoist if necessary hooks 111111! I 71 U if necessary-.._.-' apparatus recoveryj c staff 3 Hydrotherapy pool
176 Community Hos pita/s PATHOLOGY LABORATORY, POST MORTEM ROOMS Pathogens classified in UK in 4 categories: A, B, B2 and C Category A extremely hazardous: includes lassa fever and smallpox. Specimens as soon as identified must be sealed into special containers and sent to regional lab assigned for purpose. Category B include brucella spp, hepatitis B, m tuberculosis: all work on these must be carried out in exhaust protective cabinets. Lab should not be less than 18 m2, must have lockable door with glazed observation panel and also contain handbasin with bi-flow wrist operative taps, paper towel dispenser and bin near door. Other eqp includes frig, deep freeze, sto for disposable gloves, tissues, encasing jars etc, row of pegs near door for protective clothing. Discarded specimens must be sent for autoclaving. Waste drainage from most of these areas required to be in separate runs. Categories B2 and C do not require special accn but advisable design all lab to category B standard. Provision for changing vital to safety of staff: each lab must contain pegs for lab coats and each unit must store 6 sets protective clothing including boots for each staff member. Discarded clothing must be put in receptaclé for autoclaving. Each workr, off and reception area must have handbasin near exit. Staff lockers for outer clothing and personal belongings must be in separate cloakroom. Staff visiting wards must wear separate lab coats for this and these must be stored away from lab. If tea 1 Pathology dept Eastboume England DGH 1 escape stair 2 fire exit 3 films 4 lab off 5 pathologist 6 hb & particle mixing 7 coagulation & electrophoresis 8 ante-natal 9 grouping 10 pathologist 11 manual & special 12 sto 13 packing 14 centrifuge 15 blood bank 16 reception 17 wc 18 wr 19 exam 20 clerical 21 chief technician off 22 sterilising 23 outfIt preparation rm 24 stacking 25 mech section 26 balance rm 27 chromatography & toxicology 28 chemical sto 29 disposal 30 workshop 31 microbiology lab 32 media preparation 33 print rm 34 dark rm 35 studio 36 records 37 med photographer 38 wc a female b male 39 staff rrn 4ofluorescentmicroscopy 41 coldrm 42hotrm43 histologysto 44 pathologist off 45 serology lab 46 cytology lab 47 Specinien cutting 48 histology lab 49 staining & sections 50 pathology gas sto 51 recovery & wr 52 wash-up Arch SETRHA and snacks not available nearby, rest rm where these can be made must be provided. Reception area must have bench with impervious disinfection proof finish and handbasin set as in lab (above), with racks for delivered specimens and ste for spare racks etc. Specific area, not within reception or lab, must be provided for patients sent to give blood samples. Note: pathology lab must not be designed without reference to pathologist in charge. 6—- $9oj. b 4200 f900- C 4 6450—4 I II CIII Spfle 2 a 'Nuffield', 24.8 m, fixed benches with fixed service spines along partitions: has been criticised for inflexibility b 'Darwin', standard 1 200 x 600 tables associated with 150 x 2400 movable service spine: services & drain have flexible connexions to ceiling & floor points c Edinburgh', 24.5 rn2 provides free benches & fixed service spines supplied from vertical ducts: gives greaterflexibilityof layout Arch Nuffield Foundation, Lab Investigation Unit, Edinburgh University ARU 3 Typical bench with rig & built-in service 4 Fume cpd 46O 420 _________________ 7 Manesty water still _________________ 6 Deioniser small size: output 1.11/ hr, weight 13.5 kg 8 Mortuary & post mortem rm: locate loading bay where not visible from main P or visitor ar; viewing rm not clinical in character; hospital chapel sometimes used for this purpose; good ventilation needed to post mortem as infected specimens handled I I U fixed benches 00 I I I U Laboratory benches a structural ceiling 900 services ceiling ntc!_i_ 49 1 200.005 150 — 2000 II; : 5 Autoclave 2 post rnorlern ml mortuary clean i -n 9 6 Sm 6 12 18 24ff booth
Community 177 Hospitals : T345666 1 Pharmacy Eastboume England DGH 1 staff entrance 2 issue ar 3 dispensary 4 wash-up ar 5 bulk preparation ar 6 dangerous drugs & poisons sto 7 bulk sto 8 chargeable empties 9 inflammable liquids 10 incinerator 11 goods entrance 12 do a female b male 13 aseptic rm 14 sterile preparation rm 15 quality control 16 sterilising mi 17 staff rm 18 deputy pharmacist 19 chief pharmacist 20 general off 21 reception lob Arch SETRHA Many large hospitals manufacture pharmaceuticals as well as dispensing them. Some hospitals serve satellite hospitals, health centres, clinics and individual outpatients: check policies before starting design. Because goods delivered can be bulky and heavy main loading dock should be used; but because can be inflammable, explosive, corrosive, fragile, require special environment for sto: if (UK) Dangerous Drug Act (DDA) drugs, poisons, or other poisons liable to misuse, must be delivered to specially designed protected area with access for authorised persons only; ODA drugs must be transported in locked containers at all times. Sto areas should provide floor sto for large items, adjustable shelving for smaller items (300 for normal, 100 for small). Inflammable sto may contain items from other dept: must be isolated from main bldg (refer to current legislation controlling design and use). Cool sto for drugs must be kept remote from any heat source, including sun; these sto often within security sto: should be internal with controlled access (refer current legislation for design and use). Bulk sto: divide into liquid and dry powder areas; allow for storing heavy items on floor; pallet and fork-lift systems suitable for some items; allow ample room for manoeuvring fork-lift. Preparation areas include large floor-mounted mixers and steamheated pans for manufacture; small lab may be required for quality control. Required also: machine to reduce items to unit packs; sterile area to prepare and package material for autoclaving, which requires inspection, labelling and sf0 areas. Install autoclaves (large floor mounted machines) against walls so can be maintained from outside sterile area. Stills for manufacturing distilled water require piped connexion to sterile preparation area. All sterile areas require special dust-free finishes comply with stringent requirements of med inspectorate. Wash-up area requires sink, washing eqp, drying cabinets and shelving for clean and returned containers. Dispensing and messenger service area with ante-rm for empties should have counter and security sto for pharmacy boxes awaiting distribution. Hospitals which dispense to individual outpatients need separate counter and waiting area for this. LIBRARY 2 types of hospital lib, professional for med and nursing staff, lending for patients; libraries also —api 29 145—8. Professional normally attached educational areas; med and nursing lib traditionally separate. Both require bookstacks (16 books/rn) with space for browsing, work tables and, if requested, study carrels —a(3) and security barriers at entrance and exit. Area 140 m2for general hospital with post-graduate med training and similar space for nurse training school lib. Hospital without these activities will require approx 46 m2 for each profession. Patients' lib will serve both ambulant and bedfast and open for limited periods during day. 600-bed hospital may have 5000 books in area 65 m2. Provide bookstacks (26 books/rn), chairs and tables usable by elderly and disabled —a(4)(5). Bedfast patients served at bedside from book trolley (cart) —a(6). Adjustable shelving needed take large print books. Permissible floor loading in these areas should be checked as books can weigh up to 30 kg/rn run of 5 shelf stacks. All ib need small workr (10 m2) and book sf0 with shelving (5 m. 2100 pin board cassette recorder r ,/ aiiow 680 unobstnicled h to underside if for wfreefohair users t extra chair if required PHARMACY 3 Study carrel, provided for med & nursing staff; also suitable for P studying for exam iLLIAL1 2000 10 T' ;:! 4 General lib: recommended mm space between bookstacks 6 Lib trolley (cart) for taking round wards 213i 2 x 3 u 68201 5amp spareoxygen oxygen manitoid switch fuse cyiinders 5 General lib: informal layout of table & chairs allows for wheelchairs 1000 -t 450 iij 1' rurr •1 • P tjiI Ii III!I tII!I II liii!: .,,u 200 dia cyhnders at 255 C/con manifold ganges a at 230 c/c on spares racks control unit b manitoid 2 spare NO cylinders 2 a Manifold rm for small hospital b combined manifold & sto rm; gases normally sto: oxygen, nitrous oxide, nitrous oxide/oxygen, compressed air — must not be put with hydrogen oracetylene; sto must be on ground level for access for delivery vehicles from open air, not from cor; single storey, noncombustible, 1 hr fr mm, 2 brick walls or equivalent; sto normally takes manifolds & racks for spare cylinders; typical automatic manifold with 2 duty & 2reservecylinders: 1630 x 6lodeep: 1 extracylindereachsidegives5lo extra I; 2 x manifold—3600 heavy tab m .con,mons 1.__ 0 102030m 32 64966 7 Layout of teaching centre Knight Campus University of Rhode Island USA
178 Community Hos pita/s NON-RESIDENT STAFF CHANGING av number of staff on duty at any 1 time approx 20% of total employed. If hours worked by part-time staff reduced, eg to 30 hr/week, percentages As proportion of part-time staff to full-time increases percentage of total of staff on duty slightly lower. staff on duty at any 1 time tends to decrease. In all instances estimate of staffonduty %oftotalstaff full-time staff only 19 1 full-time: 2 part-time 18 1 full-time: 4 part-time 17.5 1 full-time: 10 part-time 17 1 Max percentage of staff on duty at any 1 time 3 Ancillary accn provided on peak use figures (peak use by 36 staff) 5 Layout for 150 personal lockers near user's work station 7 Bulk sto for supply & disposal bags from au: 10—12 disposal bags cater approx 300 staff/week 1 2lX0 IliIIiIi[iIWiiIHI]]iiIiilIiW bench -- .'i_i_L_L1 1 I. liii 111111 11111111 .4ljlockers.- II - I liii III 12000 S U) b S N a I I T I I I IlJ II II Ii. i41j. U I IL]tft LLLL[ IIIIJ } ii. tlIiiiLliLt mirrors I mirror brusliup l2dlangU)g spaces brush up & _J__1__L_J LJ_L_IL ar I- -6olockers IiIIIIIIIIIIiiiI 11111 Mliii II 11111111 liii [11111 11111111 I C basis of allocation approx total a lockers allocated on permanent basis, changing & sto combined i locker 300 x 550 x 1 800 0.81 ii locker 200 x 550 x 1 800 0.72 b lockers allocated on temporary basis, changing & sto combined i locker 300 x 550 x 1 800 0.43 ia with small permanently allocated lockers adjacent 0.5 c hanging baskets allocated on permanent basis: sto of baskets behind counter, changing separate or adjacent i single tier hanging baskets 0.84 ii 2-tire hanging baskets 0.63 d hanging baskets allocated on temporary basis: sf0 of baskets behind counter, changing separate or adjacent i single tier hanging basket 0.48 ia with small permanently allocated lockers adjoining 0.55 ii 2-tier hanging baskets 0.34 ha with small permanently allocated lockers adjacent 0.41 2 Space required by each employee for storing & changing clothes: only immediate circulation ar included; entrances & main corr valy according to location & number of staff involved acnn provided ar rii female staff 3 wc with hb 2separatehb 2592 2sho 1 chemical disposal bin male staff 2 wc with hb 3 urinals 25.92 5 separate hb 2 sho waiting ar informal arrangement of (peak use comfortable seating & 23.23 by 20 staff) low tables 4 Changing rm a forcomplete change using hanging baskets forclo sto—n(2), ar/P 0.48 m2, ar/Pwith personal locker 0.55 m2; b for staff required to change down to underclothes; locker 300 x 500 x 1 800; 1 changing space: 8 sto lockers; c for staff required to remove outdoor clothing; locker 200 x 550 x 1 800; 1 changing space: 5 sto lockers I 4500 I II III [liii!! -- II!IHThHHIHI 6150 S . u F I I ! I I - 6 Bulk sto for 384 sets clean unfiform tE- IIL EJI I ILII] L. LIIIII NI ILIII I' LIII IIIJ LIII 4 3600 obstruction of locker doors clearances must allow for by seated person locker doors 8 Clearances for lockers 9 Locker for staff required to change down to underclothes eg nurses 10 Locker for staff required to 11 Small personal lockers near 12 Hanging basket: loaded weighs remove outdoor clothing only user's work station about 8 kg
Community 179 Hospitals code no space untar m2 spaces totalar 1 2 3 4 5 6 7 8 9 10 11 12 business off; clerks business off: manager staff lockers staff lounge credit/collections oft credit manager credit/collections; off accounting off: comptroller accounting off; secretary accounting off; accountants accounting off; payroll accounting/audit; conference cashier; office 65 11 3 7 9 7 11 7 9 9 15 9 1 1 1 1 1 1 1 1 3 1 1 1 65 11 3 7 9 7 11 7 28 9 15 9 net arfotal 181 grossing factor (50%) 90 gross ar total 271 1 Off space allocations goods + receiving & shipping perishables to dIetary special items to maintenance central or pharmacy general sto + bulk foods linens to dietary to lau supplies * new eqP to all depl to requisitioning from dept H US eqp dept to all dept 3 CSSD functional relationships rinted form to admin ,, volatile liquids0 pharmacy separate sf0 I 2 CGS allocations commodity number of B served 2000 3000 4000 5000 6000 7000 8000 9000 10000 Sf0 Sr dry provisions 90 125 145 170 190 215 245 270 295 cold sto provisions 25 35 50 60 70 85 95 105 120 staff uniforms 45 65 80 95 105 120 140 155 170 Pclothing 5 10 10 10 15 15 15 20 20 cleaning materials 20 25 35 40 40 45 50 55 60 hardware&crockery 25 35 45 50 55 60 70 75 85 bedding & linen 15 20 25 30 35 40 45 55 60 printing & stationery 95 130 155 175 195 220 245 275 300 dressings (excCSSD) 45 60 70 80 85 95 105 115 125 CSSD dressings 20 25 30 35 35 40 40 45 50 med & surgical sundries 60 75 95 110 125 145 160 180 195 disposables 50 65 85 95 110 130 145 160 180 disposable bedpans &urinals 60 75 100 110 130 155 175 185 210 es-local authority items 65 90 105 125 140 160 180 200 215 total sto ar 620 835 1030 1185 1330 1525 1710 1895 2085 non-Sb ar 370 390 425 465 475 490 520 555 565 basic total ar 990 1225 1455 1650 1805 2015 2230 2450 2650 recommended total stoar 1050 1310 1560 1770 1940 2170 2400 2640 2860 4 DHI-1S guide to planning central sf0: required sto ar in m2 with working h between 6000 & 6500 & sto upto 5 pallets h 5Sto requirements at point-of-use over 72-hr holiday period for disposable & permanent use items: disposable items increase space required lambulant P care surgery! IP dept divisions I emergency delivery . ,1\ CGS linen (c'1 central sterile Supply ismantlina leaning all items receiving & ssembling packs sterilising toring distributing OFFICES As in other industries and services demand for admin space grows alarmingly. Can be thought of as having 2 components, 1 which processes information and 1 which uses it. Processors: such dept as med records, data processing, accounting; users: such dept as hospital admin, med staff, financial control. Admissions combine both. Space requirement for each component different: for processing dept factors: volume and type of information and eqp used or projected to be used: input changing rapidly as data processing advances; for user dept people determine spaces. Individual office spaces similar commercial offices —3235—8. People form prime design consideration: admin workers generally spend all day at their posts; pleasant environment accordingly important. Patient and med staff interface crucial. Privacy of interviews, particularly about things med and/or financial must be considered. Typical space allocations for hospital offices in USA —e(1). SUPPLY STORES & DISPOSAL Nearly all goods, except sometimes pharmaceuticals and often food, received and disposed centrally. UK daily av weight goods handled in 600 B hospital 3000 kg, waste produced 1 200 kg. Considerations relating to central general stores (CGS). Function: receiving sto, distribution of goods, supplies and movable eqp; inventory control. Main planning options: use of disposables or reusables? Systems for materials handling, conveying and transport; remote sto possibilities. Key space: service court for vehicles, sized for separate access to bldg entry points for various types service traffic—e(2). Receiving dock with levellers. Warehouse: special/secure sto areas. Main design issues: separation of incoming goods from outgoing material (supplies, eqp, perishables, trash, refuse, soiled goods); separate receipt and handling of foodstuffs; internally segregated sto and control of goods (central supply sto (CSS), pharmacy, engineering); special sf0 requirements: med gases, volatile liquids. Items classified as fragile, or needing light, moisture or dust control, need special arrangements. Items with high security risk (eg radioactive material, dangerous drugs, inflammable gases, volatile material) must be stored in accordance with legislation and reg. Guide to UK areas required —(4). Sto areas at point-of-use must allow for extra space required during public holiday periods when portering staff not available. Usual holiday (UK): 72-hr period 4 or 5 times/year—*(5). Conveying methods vary from hand-pushed trolleys (carts) to automatic conveyor systems; UK experience suggests automated system, needing trained maintenance engineers, cannot be justified on savings expected in labour costs: such systems vulnerable to mech failure or industrial action. CENTRAL STERILE SUPPLY What happens: centralised receipt, cleaning, packing, sterilisation, sto and distribution of reusable supplies (UK central sterilised supply depot (CSSD)). Special sterile processing of goods used in patient care dept, particularly surgery, obstetrics, emergency. Functional relationships Main planning options: closeness of relationship to other materials handling functions: CGS, Iau against traditional ties to certain users: surgery, obstetrics. Means of conveyance for sterile goods (dedicated or general use systems). Key spaces: decontamination, sterile processing preparation, sto and issue. Main design issues: strict separation of dirt and clean work areas, use of steriliser bank to form separation; location of sterilisation function for surgical instruments. 6 w of load carried related tow of 7 Reach & space requirements for corr on sf0 ar av woman collecting sto permanent & urinals use bedpans 24 hr 48 hr 72hr + load w cen clear w 1200 1400 1100 1300 900 1100 750 1000 600 90) 450 800 300 600
180 Community Hos pita/s HOUSEKEEPING What happens: regular, thorough cleaning all parts hospital with special emphasis on infection control in patient care areas and with respect related materials flow; refuse disposal. Option: linen handling. Relationships diagram —v(1). Main planning options: determine effect on work load of cleanliness standard desired, extent of air-conditioning/air filtration, ease of cleaning and maintaining interior finishes. Manual or mech means of conveying trash (eg pneumatic tube system)? Manner and means of trash disposal (—±lau/linen services). Key spaces: housekeeping materials sto (ie maids/janitors cpd, eqp sto); staff training area/admin. Main design issues: size and distribution of cpd; centralisation of eqp/materials sto. LAUNDRY/LINEN SERVICE What happens: dirty linen collected at points of use, conveyed to centralised sorting stations; washed, extracted, dried, mended, ironed, stored. Clean linen distributed user dept according quantity and time schedules, If outside commercial service used linen counted and weighed when sent and received; dirty collection and clean distribution functions remain unaffected. Main planning options: linen load: operating policies on linen use depend upon disposals against reusables —epi 79(5). Dirty linen collection system: handling and accumulation at points of use, means of conveyance to sorting station, infection control, volume of cart/trolley traffic, overall cleanliness. Clean linen distribution: cart/trolley system to user dept, sf0 system in units. Inventory control: preventing wasteful use, excessive wear, loss from pilfering. Key spaces: dirty collection and holding: hamper packing, chutes and vestibules. Lau: area, shape and height for efficient handling of material and for employee comfort. Clean linen distribution and sto: cart/trolley parking, shelf-cabinet sf0. Main design issues: degree of decentralisation in bed units of nurse work areas and supplies/linen sto. Pneumatic system expense against general cleanliness in patient units and corridors. Functional relationships cart receiving 3 Food service relationships DIETARY SERVICES Most space-consuming of all service elements. What happens: meal service to several hospital populations: inpatients, staff, ambulant patients, visitors. Procurement, diet planning, food preparation, distribution to inpatients by transport means, others by serving line and dining rm; dishwashing and cleaning of dirty returns. Main planning options: form of distribution: bulk transport from central kitchen to local stations in patient units against centralised tray make-up Key spaces: central kitchen: receiving and sto, preparation, cooking, dish-washing, scullery, waste, trash and garbage disposal. Dining (for staff, visitors, ambulant patients); service line, table seating; local distribution stations; nursing floor kitchens or pantries. Main design issues: means of distribution of inpatient meals. —uFunctional relationships food services—v(3). In UK trend towards tray service from kitchen as opposed bulk supplies to ward —v(5): patients can choose menu day before. Food may travel several km before reaching destination: insulated trays and plates on heated carts/trolleys essential. Diet kitchen provides both med and ethnic diets. Machinery noise and vibration can be disturbing, particularly potato peelers, food mixers and central wash-up machinery. All ventilators and grilles removable and washable. Floors and walls: impervious easy clean finish; floors non-slip; floor drains must have grease traps. 5 Kitchen area Wycombe DGH England, serves 650 meals/sitting; individual food plates prepared for P on conveyor belt; tilled tray taken by trolley to wards by lift; used trays & crockery washed centrally 9 ..—.-—------.main flows of sb & food staff foodhom day iarder 1 scraping bench 2 crockery washed 3 centrai wash-up 4 dining crockery sin S service eiovator to wards 6 eqpsto 7 cartJtroiiey 8 dining servery 9 staff dr 10 conveyor Deft 11 ward servery l2barderraii l3dietk l4dietoff l5ia l6refusesto l7stuilrm l8sio lgteabar 20chefoff 21 cio a femate b maie 22 main k 23 vegetabie preparation 24 vegetabie sin 25 day ia 26 dry goods sto 27 plant rm 28 fish preparation 29 meal preparation 30 pastry preparation 31 pot wash 32 domestic supervisor 33 corr 34 meat fresh 35 caienng officer 36 ramp Arch Oxford At-IA 2 Lau/linen service relationships Housekeeping relationships 4 Hennepin County Medical Center Minneapolis USA has automated delivery services including monorail-style track & chain conveyor network with moving Hennepin county lockers & containers for carrying food preparation files, all kinds of materials, medicine service & food, delivered from separate food preparation bldg Arch Medical Facilities Associates — General typIcal gaflery
Community 181 Hospitals 1 Clydebank Scotland HC ground floor with wings for local health authority, hospital services & GP, some amenities being shared 1 consult 2 interview 3 disposal 4 waiting 5 drugs 6 wc 7 treatment 8 lob 9 test 10 typist 11 sterile sto 12 sto 13 telephone 14 switchboard 15 secretary 16 records & reception 17 entrance 18 play centre 2 Crieff Scotland HC 1 consult 2 dirty uty 3 urine test 4 wr 5 health visitor 6 telephone 7k 8 staff 9 boiler 10 disposal 11 do 12 toilets 13 reception 14 treatment 15 entrance 3 Dental suite, 2-man practice; dental chair (165—200 kg), dental unit (51 kg) need firm fixing to floor; services required: water, waste, gas, el, compressed air 1 hb 2 couch 3 curtain 4 armchairs 5 recovery rm 6 steriliser 7 aspirator 8 sk 9 disposal 10 dental chair 11 small dental surgery 12 worktop 13 dental eqp cabinet 14 operating lamp 15 cartltrolley 16 anaesthetic cart/trolley 17 desk 18 large dental surgery 19 gas outlet 20 bench with bench pin 21 waste hole bin below 22 dust extract 23 duckboard 24 dental workshop 25 filing 26 DDA cpd 27 dental unit 4 Chiropodyrm,11.0m2 COMMUNITY HEALTH CARE Community health care in UK, alongside general practitioner (GP), now principally provided by health centre (HO). In USA 'free-standing' ambulatory units fall into several categories, in addition to physician's office, generally with twofold aim providing preventative medicine and making available health care at lower cost than involved in full hospital treatment. Each such unit starts with programme worked out meet market needs within service area, community or region. Various types unit include Health Maintenance Organization (HMO), founded some 40 years ago as alternative insurance programme for industrial workers, primary care centres in rural areas tor emergency exam and treatment (include pre-hospital beds), community health and social centres usually founded by local or regional government. Each of these may contain some, all or more services than UK HC. Larger ones often attached hospitals. HC primary activities: consult, exam and minor treatment backed by med records, reception, waiting and sto areas. Basic amenities must include: pram and car parking, wc for patients and staff, changing areas, rest rm with kitchenette for staff. Secondary activities for large HC may include diagnostic and treatment services — physiotherapy, chiropody, dentistry, radio diagnosis and pharmacy — and health clinics for education and assessment, off for health visitors, domiciliary nurses, social workers etc. Viable size for HC consulting resources for not less than 6 GP, but as vital to place HO near population served may be smaller and less well equipped in rural areas. On basis 1 GP has approx 2500 patients, centre for 6 GP will serve population of 15000 and for 12 GP 30000. Assume health visitor can cover approx 3500 and district nurse 2500 people. Sites must be near public transport routes; access from roads and car parks must be designed for wheelchair —p19 43 166 and pram users. Entrances should be protected from rain and prevailing winds and have covered and well supervised pram park. Allow for protected disposal area for waste: check with local authority or health authority how to be collected. Large centres may require separate staff and service entrance; patients entrance may need canopy high enough take ambulance —p166(2). HO grounds should be attractive but simply landscaped for mm maintenance. Many rm in HO serve same purpose as equivalent rm in OPD: same layout can be used with minor adaptations. Main difference: HO do not deal with such large numbers of patients; nor do they deal with acute med and surgical cases needing sophisticated diagnostic and treatment eqp. Rm which can easily be adapted for HO are set out —+p166—7; most important are: wheelchair wc p167(6), disposal rm, p167(8), dinette & urine test rm, p167(5), ambulance dimensions, p166(2), automatic doors, p166(4), disabled patients car parking, pl66(3). Waiting Provide general waiting area. Small forward waiting areas required for each group of consult rm. Assuming appointment system, allow 7.0 n? waiting area for each suite. Seating should be comfortable and informal. Med records Med records in 2 sizes: standard 175 x 125, new A4 in folders 310 x 240. Sto may be in shelves, filing cabinets or rotary filing units. Including access these methods require floor space 1 .5—2.0 m2/1 000 records. Shelves cheap but offer no security; cabinets expensive but secure and adaptable; rotary not secure and expensive. Allow for increase in numbers of records. Dental clinic —(3) Dental clinic for 2-man practice consists of 2 surgeries (1 large enough for principal surgery), recovery rm with couch and basin for postanaesthesia patients, dental workshop and waiting area plus normal central records and reception area. Allow 9.5 m2 waiting area for 2 surgeries. Surgeries should have NE aspect if daylight needed but trend towards theatre-type operating lamps and more mobile eqp. Obscured glazing required for windows. Chiropody room —(4) Should be on ground floor or accessible by elevator. Hospital references: —*Bibliography entries 013014017020022023024025 054 218219 220 262 294 296 303 315 336 337 341 349 354 362 419 420 421 478 525547551 559560576577578647 O 5 10 15 20 25m 15 30 4 oh 75ft 9 lp 15m 15 3b 455 3200
182 Commerce Churches communion 'Iss,y — - chapel — pulpit II Lrr 4 St Paul Bow Common (Anglican) London England Arch R Maguire 6 Roman Catholic church Cologne-Rietil Germany Arch D Bôhm — —altar stage pulpit. sacrlstry- • UI wc J k(tea) 9 Notre Dame du Raincy (Roman Catholic) Paris France Arch A Perret key 1 sanctuary 2nave 3pulpit 4baptislry 5secondaryaltars 6 confessional GENERAL ARRANGEMENT Main divisions of Christian churches today: Orthodox (principally Greek and Russian), Reformed, Roman Catholic, separation between Orthodox and Roman dating from earliest history of Christianity, break between Reformed and Roman Catholic from 16th century. In Roman Catholic churches emphasis now placed on mass in common tongue; altar usually raised. Reformed order of service depends on whether 'high', 'low' or 'free'. Some likeness between forms of Roman Catholic, High Anglican and High Presbyterian (Scotland and USA). Free follow Calvinist and Lutheran origins with emphasis on preaching and communion carried out round 'Lord's Table', usually centrally placed with nearby pulpit either behind table or to left hand side. Baptists need large heated water tank usually under removable floor for inititiation by total immersion. Fonts used almost universally for initiation into main groups and dedication into others. Many newer religious sects have idiosyncratic requirements related to special forms and musical performances. In USA Protestant churches have approx 70 million members, Roman Catholic 50 million, Orthodox 4 million. Churches throughout world now have strong community concern; planning often relates to weekday uses; keyword flexibility. Ancillary accn, according to programme, may incorporate, eg coffee rrn, counselling rm, meeting rm, radio station. Car parking must be taken into account. Centralised plan popular; but ritualistic, processional and oblong forms also used. However, importance of priest, pastor or leader should not be lost; liturgical functions carried out by individual churches of great importance in design. More recently new factors have emerged, among them security of church property, adequate acoustic design (for music and voice) and provision for disabled. ha for orchestra vestry sacnsty pulpit ha for altar communicant sarcophagus celebrant's chair high altar sacristyflC communion dom CflOi,tl side altar i_tp1p1t I baptistryIf' & choir towers 4N t 1 Design for Berliner Dom (Lutheran) Germany Arch Schinkel 2 Typical Roman Catholic church layout entrance font lady chapel —i high with lantern over pressionaI door sacristy communicants wc tar pul font high altar sacristy side congregationa chapel erPU2 9 5 Circular Protestant church Essen Germany Arch 0 Bartning 10 Orthodox church of St Sava McKeesport USA Arch Pekruhn 7 Corpus Chnsti (Roman Catholic) church Aachen Germany Arch A Schwarz 8 Church & parish ha (Reformed) 1-lanweiler Germany Arch R Kruger "-i' ¶ii 2 llI—i11 --4— - ---F — --f11 St Michael Hatfield Hyde (Anglican) Welwyn Garden City England Arch Clarke Hall Scorer & Bright key 1 entrance 2 chapel 3 vestly 4 pulpit & lectern 5 baptistry 6 altar with baldachino
Community 183 Churches INTERIORS, FURNISHINGS a = 800—900 seat w = 500-550 Seating hat hook In some churches provision for worshippers — to kneel not necessary eso —(1); in others simple hassock or kneeler incorporated in bench —(2). I Most important measurement for benches with kneelers: distance of 350 outside edge of kneeler, when folded down, from perpendicular dropped 160 from arm rest: approx 175—200. i50fJt _________________ Area/seat required: without kneeling rail 0.4—0.5 m2 —(1); with kneelheating ing rail 0.43—0.52 m2—(2). Aisles Dimensions —*(3)—(6). Cold radiation from external walls makes side aisles advantageous. Central aisle useful for processional entry and exit in larger churches. In UK aisle should be provided for every 8—10 persons length of bench (benches more than 10 persons long need aisle at each end — in USA more than 7 persons). Including aisles allow 0.63—1.0 m2/P. For standing allow 0.25—0.35 m2; on crowded occa- _________ sions wall space and rear aisles may be used. Width of exit doors and stairs should comply with reg for places of assembly —*p401. Pulpit _________ Requirements vary from church to church —(7)(8)(10). Usually raised with steps; but growing practice also place on level of sanctuary or raised 1 step. In Roman Catholic churches pulpit now likely be replaced by 2 ambos or reading desks, 1 at each side. In 'free' churches pulpit of central importance. In all churches essential preacher be visible to whole congregation. Altars —(9) _________ In Reformed churches altar usually placed close rear wall; may have __________________________________________________________ passage at back. Many Roman Catholic and some Anglican churches 3—6 Aisle now have altar in centre of sanctuary: priest or celebrant stands behind ___________________________ __________________________ to face congregation for purpose of worship. Roman Catholic and some Anglican churches have sacrament house or tabernacle (small decorated cupboard with lockable doors, bolted down and immovable: —*catalogues of church furnishers): may be in side chapel or on plinth behind main altar, some 2000 away. Separate side chapel sometimes desired. Font Used for baptism; often symbolically placed in or near entry of church, though in Protestant churches in USA sometimes placed conveniently for baptism to form part of main service. May be 1 or 2 steps lower than, and separate from, main body of church (baptistry —p1 82(2)(9)(1 1)), with room for up to 30 people to stand during baptism. For Baptist _________________________ _________________________ churches immersion tank —p1 82. 7 Pulpit & attar in same axis 8 Pulpit sideways to altar — Confessional boxes Best placed in aisles: separate compartments for priest and penitent —*(13). Construction must be sound proof. 11 Lectern 12 Font 13 Confessional box a = 850—950 b = 50—140 Seat w = 500—550 I Seating without knee rail 2 Seating with knee rail _____ I T 2 __ J. _____ 4 5 T' 6 _____ pulpit) lectern 4t font centre line of aisle Sacristy altar pulpit centre line of aisle 9 Altar table for small reformed churches 10 Pulpit (microphones have made sounding board unnecessary) 550 550 550
184 Community Churches view over shoulder & head shoulder view over 100—140 1 Gallery seating tiered, risers with lighting: must be possible see altar or at least pulpit over heads of occupants of second row in front 3 Chamber organ (Walcker-Jahn) with about 275 pipes for ha 5 Organ & choir: organ console in front of conductor, organ divided 2 Small organ (Walcker type) with 15 stops for church ha & smaller churches 4 Organ with manual closed by roller shutter 6 Organ & choir with harnionium & organ placed to each side, otherwise as 5 GALLERIES, ORGAN Galleries Increase seating capacity for same area; also improve acoustics if suitable distance from pulpit: common in Reformed churches. Have tiered seating so that congregation at back may see and hear better. Convenient positions: opposite altar wall (for organ and choir) or sideways opposite pulpit. Height of gallery determined by necessary free sight of congregation beneath it in relation to altar and pulpit. Stairs and exits from galleries must comply with reg for assembly halls. RequirementlP 0.7—1.0 m2 inclusive of gangways—(1). Choir galleries In front of organ —*(5) have 100—150 high steps (increasing front to rear) and are 1 000—1 200 wide. If desirable choir on loose chairs arranged in semi-circle in front of conductor; if necessary organ console can also be in front of conductor with orchestra seats built up behind to achieve unity between organ, orchestra and choir. Next to conductor's desk and organ console large cupboard for music sheets; outside gallery suitable cloakrm for choir members. Organs Specialist should be called in for organ installation (acoustic specialist also important). Size of organ (number of voices and stops) not simply relative to size of church as volume variable, but generally: smaller churches 200—300 m3/voice medium churches 300—400 m3/voice larger churches 400—500 m3/voice Each voice needs width of 2000—3000 and 250 depth. Each voice weighs 200 kg therefore 10-stop organ needs area (if 3000—4000) h of 10 (3 x 250) = 7.5 m and weighs 10 x 200 = 2000 kg, therefore approx 300 kg/m2. But organ specialists ask for 750 kg/m2. Height determined by length of pipes. Largest: 32 ft open voice pipe 11 m high with sounding board; is passed through several storeys or may be bent. Determining factor: 8 ft pipe, 3000 high with sounding board. Therefore storey height for smaller churches may be 3000—4000, for larger churches 4000—5000. Organ may be divided —*(5). Bellows best in separate rm if possible. Organ builder should be consulted at planning stage, also regarding appearance of visual pipes. In USA organs often electronic. 7 Section through Vuoksenniska church Imatra Finland with gallery & organ Arch Aalto 8 Roman catholic parish church with organ & choir gallery at Wend Arch Schwarz 1300—1600 organ :j: j±4rgan I I \\Lorganist steps (Or choir \ ,organ console 120h V conductor orchestra main organ bellows do'— I: I music I sheets / '.W organist steps for choir rgan 120 h harmonium conductor console 1J ft
Community 185 Mosques domed ar c,vermihrb .•... - I.. - ' court - 1•- I..i I.. m ______ 32 64 tt gateways 3 Mosque of az-Zãhir Baybars: 1266—9 AD 2 Friday Mosque Isfahan: 8th—I 7th centuries AD Mosque place of prayer for Muslims: not necessarily bldg. Term derives from masjid, meaning prostration. Prayer as community act not mentioned in Quran but derives from prophet Mohammed's Friday communal meetings. Friday sermon (khutba) set piece, made from top of stairs (minbar), often incorporated as feature. Early mosques characterised by wide and shallow shape —÷(1 )(2) to enable ranked formation of believers face mihrab wall. (Mihrab itself is niche resembling door: highly decorated feature in later examples.) Holy mosque at Mecca, most holy sanctuary of Islam, to which all mosques should preferably face (arrows in illustrations), houses ka'bah. Ka'bah stands in huge courtyard surrounded byarcaded precinct which forms pattern for many subsequent examples. However, mosques vary extensivey throughout Islam from square village hall types to great historical examples in Egypt, Syria, Spain, Iran, Turkey and India. Few purpose built examples in W: many sects, with varying needs, adapt or rent existing bldg for Friday prayers and for the two id celebrations, for Islamic new year and end of Ramadan. 3 main types of traditional mosque: early open plan, usually to be found in desert regions; central court, patterned after Mohammed's house at Medina; open court, with 4 vaulted halls (iwans) 1 on each side of court. Mosque bldg have followed climatic needs for shade through use of arcades, colonnades and courtyards incorporating areas of water — most important for ablutions but also for cooling. These elements often used symbolically in designs and heavily ornamented or planned as landscape features round mosques. Main architectural feature mihrab basic to all mosques: set in wall facing Mecca (k/b/a wall), often emphasised by windows or by dome above. Monumental grandeur of mosque came largely through need to enclose activities in harsher northern climates but also related to advances in vault construction in 11th and 12th centuries AD; thus domed mihrab area was enlarged by single vault prayer hall or 4 vault iwans or //wans arranged symmetrically around court. Tendency use this pattern with open or closed courts according to climate. Minaret 'Call to prayer' tower often attached to mosque: name derives from 'lighthouse'. After introduction of loudspeakers little used for calling. Types vary from none to cylindrical needle minarets in glazed tile with 1 high gallery, common in Iran; type with 2—3 galleries capped with wood cones and based on polygonal plan in Turkey; often 2—6 minarets per mosque in some countries, depending on size. Segregation Male worshippers only in most mosques although gallery for women often found. Some sects, eg Ishmailis, fully integrated. Ablutions Requirement of the faith; modern western examples —e(7) include these with other toilet arrangements in part of bldg next to nearby congregation hall. Planning Because of ranked formation allow 680—1 250/standing P in congregation hall. Carpets and other floor coverings required as faithful are barefoot: sto space for shoes required. Axial layout common but open courtyard for prayers useless in W climates. Decoration Accepted generally should be non-representational although not decreed. This rigidly observed tradition, however, allows free use of calligraphic devices from Quran which forms valuable counterpart to plain surfaces and basic architectural forms. m,hr6b wall © uL;: li awt entrance ::;::::: : i i:::.:j L±L flJL. • ,4:::::::: 1 Simple mosque arrangement: Tlemcen Mosque of al-Mansur 1303—1306 AD 4 Mosque & court Sehzade Mehmet Istanbul: 16th century Arch Sinãn I-+4 • 0 lOm dorne53mh mrhrab 5 Suleymaniye complex including mosque Istanbul; covers 6000Cm2 & includes numerous ancillary bldg Arch Sinän b,ns sunke garden 0 5 10 15 21) rn •244 It makkarl 6 London central mosque a ground floor b lower ground floor _____________________ Arch Gibberd & Partners
186 Community Synagogues No formal architectural precedent for synagogues (literally 'assembly); tend to follow architectural style of country in which built. Dual function of place of worship and of social or community meetings tends demand complex of bldg. 3 divisions of Jewry all require space for prayers; conservative and reform Jews use choir and organ but orthodox Jews do not use instrumental music. Liturgical furniture consists of: ark, focal point generally at E containing scrolls; paroches, curtain-type covering; candelabrum to right; pulpit for rabbi and cantor. Furniture mounted on berna, raised platform at centre (orthodox) or end of hail (conservative, reform). Second commandment proscribes 'making of graven images, so ornamentation floral or geometric. 2 Jewish Centre West Orange USA: all week social, religious & educational use; chapel seats 250—350; multi-purpose rm up to 750 on high holy days Arch David Brody Juster & Wisnuewski 3 Beth Israel Synagogue & school Omaha USA: seats 650 in sanctuary & extra 800 in congregational assembly ha; courtyard provides additional multiuse flexibility 1 congregational h 2 synagogue 3 rostrum 4 stage 5k 6 sto &uty 7foyer Bcantor 9rabbi 100ff 11 chapel l2court l3classrrn Arch Kivett & Myers 4 Temple Beth El USA: normal seating 1000 can be extended to 1600; bldg includes provision for religious education, lib & dramatic presentations 1 temple 2 retiring rm 3 chair sto 4 classr 5 supply & mimeograph rm 6off 7coveredentrance 8vestibule 9lob lotemplegarden 11 pool 12 chapel 13 social ha 14 social garden 15 ante-mi 16 rabbi off 1 7 women 18 men 19 lib 20 stage 21 k 22 dressing rm 23 driveway Arch Percival Goodman 5 Plan of main floor Park Synagogue & community centre Cleveland USA Arch Erich Mendelsohn I : 12 - . 9 0 2 3pm 3b do 9 1 5 Om 1 0 45 don 9 8 L6 12 .7Ii 7 6 2 14' 21 .3 4 ic 1 1 KTI Synagogue New York: accommodates up to 1 000; note flexible space for social andlor religious use 1 social ha 2 sanctuary 3k 4 entrance foyer Arch Philip Johnson 23 0 10 20 p 4 5 m odo9o1o ft
Community 187 Mortuaries and crematoria 1 3l0—, 450—600 350 780—900 , 750—1100 MORTUARIES Dead kept in cells separated by partitions (usually sheet metal, sometimes plants) —v(3). In larger mortuaries gangway for bearers separated from visitor's —(3b), from which relatives may see dead through airtight glass panes before funeral service. Protruding piers between cells prevent inconvenience to different groups of mourners —s(3b). Usual dimensions of cells: 2200 x 3500 2500 x 3750 3000 x 3500 Temp in mortuary: 2°to 12°C; if it fell below mm figure frost could expand corpses. This temp range maintained by central heating, air conditioning and, specially in summer, ventilation. Floors mut be impervious, smooth and easy to cleanse; walls best lime washed (frequent renewal advisable). Larger mortuaries also need rm for guard and bearers 15—26 m2 inclusive of toilets and lavatories. Stand for hearses also needed. In city morturaries special rm may be set aside for unidentified bodies with sto for their clothing, next to which locate post-mortem rm and surgery —s(6). CREMATORIA Furnace room Should be either on lower floor with lift for coffins —n(4) or behind chapel, separated from it by lobby —v(5)(6). Horizontal transport with handoperated winches easiest, hydraulic lifts being necessary for vertical movement. Lobby door or floor trap designed to shut slowly as coffin disappears through opening. In furnace rm coffin taken from transport carriage and transferred to chamotte grating in furnace. Cremation performed by special coke, el or gas-fired furnace consuming 45 kW per cremation. Height of 2-storey furnace 4300. Cremation completely dust free and odourless by means of 900—1 000°C dry air; no flames reach deceased. Furnace pre-heated for 2—3 hr and cremation itself lasts 1—1 1/4 hr after which ashes gathered in iron box for sto in urn. Cremation supervised through peep-holes. Chapel Cremation installations should if possible lie at rear of cemetery chapel, which serves all denominations. Size of chapel varies: must be at least 100 seats and 100 standing places; also 1—2 rm for relatives (which may be added to chapel rm) and such ancillary rm as may prove necessary Administration Conveniently close by chapel should be admin rm: 1 for director, 2—3 offices, coffin sto, flats for cemetery keeper and boilerman etc; nursery can be located nearby, with greenhouse —+pl 11, rm for gardener and landscape architect, worker's rm, sto for eqp and seeds, and toilets. Urns & gravestones Often limited in size by cemetery reg —(1); wall niches in columbaria usually 380—400 wide and deep, and 500—600 high. 1 Urn & coffin 2 Mm w needed by bearers 1 ... :. :. .1 bearers 8 I i visitors visitors I visitors C'J I CJ LLIL!LLIL huH a bearers I bearers (::..:.:::.i 250O 3 Mortuary layouts [acnn T wreaths j,_,Ob,,j wreaths proiestani rails catholic priest priest coffin chapel — — 4 Plan of installation with furnace below chapel 5 Furnace rm behind chapel with intervening lob I drive Religious buildings references 6 Layout of mortuary with crematorium and ancillary mi for large cemetery —Bibliography entries 005 070 072 160 184 311 312478 579 620
188 Commerce Shops & stores 2 Free standing modular sheMng units make up major part of furniture in modem establishments SITUATION Prominent sites in population centres served by convenient public and private transport. Car parking standards in UK, 3.5—5.25 car spaces per lOOm2 gross retail area (3—4 changes day). In USA max 150 cars/acre. Access Pedestrians, vehicles and delivery traffic should be kept separate; shopping centre best restricted to pedestrians, short connexions (covered to protect from sun and rain) linking parking area and shops. Bus stops or underground railway stations may be adjacent to shopping centre with direct access. Max distance between shopper's car or bus stop or station and principal shops should be 201 m and should be within inner distribution road system. Space allocation —*(l) Large stores may have lecture and demonstration rm, restaurants, cafes, kindergartens, banks, post office, travel agencies, cinema and garden area. Small shops often grouped in shopping centre —*pl 99—201. Design begins with allocating space to units, conforming to tire and other reg, followed by subdivision into sales areas, internal service areas, joint services etc. Sales areas Should be immediately above one another and as near entrance floor as possible. Basement better for selling than additional upper storey, so stock rm and staff rm best located on upper storeys, with offices on highest floor. Storey heights For large units, 4000—5000; for small units, 3000 dependent on services (UK practice). Unnecessary floor to floor heights deter customers and are tiring to staff. Shop units do not rely on natural light but on artificial lighting with mech ventilation. Structural grid Column dimensions and centres determine lay-out of fittings. Recommended structural grid: large units, between 7300 and 9000 width on frontage and 9150 depth; small units between 5300 and 6000 width on frontage, 18 to 36 m depth front to back. Aisles Recommended mm aisle width: 1 980, subsidiary aisles 990. Counter heights generally 920. System modules vary according to type of shelving and bracketing used. each floor stock rm controller/buyer admindirectors personel accounts advertising taff accn canteen lockers training rest rm lecture rm medical care 1 Plan analysis of rm & routes of customers & goods main passage i200N main passage 3 J13 EBEB1 —. § main passage E 3 Functional display stands for different types of merchandise with units running between equal column centres 20i- 40 +266 420-1 14 Ft I LJ1 T f144 II 110 LI; flH . 11I1 _____ j - 20 - 100 —iii 41 4 Arrangement of furniture units 5 Section through shop sales floor with aisle w which have proved practical in use for personal service